A/R Specialist

1 - Position Summary

• Key Responsibilities1. Eligibility & Verification (EV)Verify patient insurance benefits prior to appointments and procedures (commercial, Medicare, Medicaid, and specialty plans).
• Confirm coverage for dermatology services, including biopsies, excisions, MOHS, phototherapy, cosmetic exclusions, and injectable medications.
• Identify and communicate plan requirements such as referrals, deductibles, copays, and out-of-pocket limitations.
• Update patient accounts with accurate insurance details and verification notes.
• Contact payers to resolve unclear, inactive, or terminated coverage.

• 2 - Prior Authorization (Auth)Obtain prior authorizations for dermatology procedures, medications (biologics, isotretinoin, topicals, etc.), and diagnostic services.
• Submit documentation including clinical notes, pathology reports, and treatment plans needed for approval.
• Track and follow up on pending authorizations to ensure timely determination.
• Communicate authorization status to providers, patients, and scheduling team.
• Appeal denials by submitting additional records or assisting providers with medical necessity documentation.
• Maintain accurate log of authorizations, expirations, and case numbers.

• 3 - Accounts Receivable (AR)Monitor aging reports and follow up on unpaid claims with commercial insurers, Medicare, and Medicaid.
• Correct claim denials related to eligibility, coding, medical necessity, and authorization issues.
• Submit reconsiderations or appeals when appropriate.
• Post insurance payments, adjustments, and patient balances accurately.
• Resolve patient billing inquiries professionally and clearly.
• Work collaboratively with billing, front office, and clinical staff to reduce recurring AR issues.

• Required Skills & QualificationsExperience in medical billing/insurance verification (dermatology experience preferred).
• Strong understanding of CPT, ICD-10, and dermatology-specific coding basics.
• Familiarity with insurance portals (Availity, Optum, AZ Medicaid portals, Medicare, BCBS, etc.).
• Knowledge of prior authorization workflows for procedures.
• Ability to read EOBs/ERAs and understand denial reasons.
• Excellent communication, attention to detail, and follow-through.
• Proficiency with EMR/EHR and billing systems ModMed is +++.