Accounts Receivable Specialist - Audit & Appeals

Accounts Receivable Specialist – Audit & Appeals

Position Summary

The Accounts Receivable Specialist is a focused role within the Revenue Cycle team, responsible for managing advanced audit and appeals activities. This position requires expertise in identifying and resolving denied or underpaid claims, executing specialized appeals strategies, and collaborating with cross-functional teams to ensure accurate reimbursement. The Specialist will work closely with leadership to maintain compliance, optimize collections, and enhance overall revenue cycle performance.

Key Responsibilities

Audit & Appeals :

Conduct detailed audits of denied, underpaid, or complex claims.

Prepare and submit appeals to various payers, including redetermination and reconsideration levels.

Identify denial patterns and root causes; develop recommendations for process improvements.

Claims Management :

Review and validate complex claims for accuracy prior to submission.

Collaborate with internal teams to resolve discrepancies.

Compliance & Documentation :

Ensure all appeals and audit activities comply with applicable regulations and company policies.

Maintain detailed records of all audit and appeals activities for tracking and regulatory review.

Collaboration & Reporting :

Work closely with the AR Supervisor and Revenue Cycle leadership to provide insights on denied claims and recovery trends.

Support ad hoc analyses of appeal success rates, denial trends, and other revenue cycle metrics.

Required Qualifications

3+ years of experience in accounts receivable, revenue cycle, or related roles, with a focus on audits and appeals.

In-depth knowledge of payer regulations and appeals processes.

Strong analytical skills and attention to detail.

Ability to handle complex accounts and make data-driven decisions.

Excellent written and verbal communication skills for interacting with internal teams and external partners.

Proficiency in MS Office, especially Excel; familiarity with billing or ERP systems preferred.

Preferred Qualifications

Experience with Medicare, Medicaid, VA, or commercial payer processes.

Prior experience contributing to process improvement initiatives.

Why Work in This Role

Participate in a specialized, high-impact role within a growing Revenue Cycle team.

Opportunities to influence process improvements and cross-functional collaboration.

Competitive compensation and benefits package including medical, dental, STD / LTD, life insurance, 401k, paid vacation, and holidays.

Appeals