Job Description

Description

Bay Area Retina Associates is a group practice of highly experienced ophthalmologists specializing in cutting edge retinal treatments. BARA has 10 convenient locations in the Bay Area with over 40 years in the industry.

The AR Specialist drives the resolution of insurance accounts receivable by identifying root causes, correcting billing discrepancies, and ensuring adherence to payer requirements and compliance standards. This role takes an active part in developing and improving procedures, systems, and protocols that support accurate, timely reimbursement across the revenue cycle.

Responsibilities

• Conduct thorough follow-up on patient accounts to maximize reimbursement, including monitoring and working assigned claim and AR worklists.
• Identify and resolve insurance-related issues impacting patient accounts, including credit balances and payment discrepancies.
• Contact payers to pursue appeals, reconsiderations, adjustments, claims corrections, and documentation requests necessary for claim resolution.
• Monitor and resolve clearinghouse rejections to ensure timely and accurate claim transmission to payers.
• Bill secondary claims accurately and in accordance with payer requirements.
• Escalate unresolved payer issues through appropriate grievance protocols in a timely manner.
• Collaborate with RCM team members to resolve outstanding balances and support overall revenue cycle performance.
• Partner with RCM Leadership to clarify billing and documentation policies, address ambiguous guidelines, and flag potential billing issues related to insurance carriers and payment resolution.
• Monitor, track, and report payer trends or systemic billing issues to RCM Leadership proactively.
• Maintain working knowledge of payer-specific contracts, including timely filing requirements, contract rates, and reimbursement terms.
• Stay current on healthcare regulations, state-specific rules, and insurance plan requirements affecting billing and collections.
• Handle insurance correspondence professionally and in accordance with departmental protocols.
• Meet or exceed department qualitative and quantitative performance targets.
• Other duties as assigned.

Requirements

Education

• High School Diploma/GED
• Business Admin, Healthcare or other related field degree

Experience

• 2 years of billing in Medical Office or Hospital
• 2 years of EMR/EHR experience
• 1 year of Clearing House
• 1 year of NextGen PM systems

Other Requirements

• Making Decisions and Solving Problems- Analyzing information and evaluating results to choose the best solution and solve problems.
• Establishing and Maintaining Interpersonal Relationships- Developing constructive and constructive and cooperative working relationships with others and maintaining them over time.
• Evaluating Information to Determine Compliance with Standards- Using relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards.
• Getting Information- Observing, receiving, and otherwise obtaining information from all relevant sources.
• Analyzing Data or Information- Identifying the underlying principles, reasons, or facts of information by breaking down information or data into separate parts.
• Guiding and Motivating
• Monitor and execute work on RCM initiatives
• Run reports for analysis, trending, and subdivision of work to communicate to key stakeholders
• Communicate trends and root issues through proper lines of reporting
• Meet productivity and Key Performance Indicator standards
• Resource person for coding specialty
• Some travel may be required

Benefits

• Medical, Dental, Vision and Life Insurance
• 401(k)
• PTO

Salary Description
$24-$31