ACCOUNTS RECEIVABLE SPECIALIST

Job Description

Job Description

About Legent Health

At Legent Health , our mission is simple yet profound: “To provide first-class health care that puts YOU first.”

Our vision reflects our commitment to excellence: “Through robust physician partnerships, become a nationwide leader in compassionate, quality healthcare focused on the patient and available to everyone.”

Our values, also known as our brand pillars, define how we stay true to our identity in the healthcare industry and the communities we serve. These values are central to everything we do:

• Respect: We honor the time and trust of both patients and physicians by delivering organized, efficient services that ensure a seamless healthcare experience.
• Service: We are committed to highly personalized care for patients, their families, and the physicians who serve them, driving optimal outcomes for all.
• Leadership: We strive to be a trusted leader through innovation, clear communication, and unwavering dedication to excellence across our employees and partners.

Joining Legent Health means being part of a team that lives these principles every day, as we build a future focused on compassionate, quality care.

About the Role

The AR Specialist will oversee accounts receivable management and denial resolution for inpatient and outpatient procedures in spine, orthopedic, ENT, and pain management. This role is responsible for managing aging AR, investigating claim denials, and working closely with our external billing vendor to ensure timely follow-up and resolution. The ideal candidate will conduct in-depth, claim-level reviews to uncover root causes of nonpayment—such as coding issues, missing documentation, authorization gaps, or medical necessity requirements—and partner with internal teams to support appeals and implement corrective actions. This position is critical to driving cash flow performance and minimizing preventable write-offs across high-value procedural service lines.

POSITION’S ESSENTIAL RESPONSIBILITIES: 

• Research each claim, reviewing EOBs, provider notes, payer policies, and medical necessity guidelines.
• Research each denied claim at the claim and line-item level — thoroughly review EOBs, payer denial data, medical documentation, provider notes, and applicable payer medical necessity guidelines.
• Perform root cause analysis: dissect denials by CARC/RARC codes and identify underlying causes—coding issues (CPT/ICD‑10/modifiers), medical necessity criteria, authorization lapses, documentation deficiencies, timely filing, provider credentialing, etc.
• Coordinate with billing vendors by communicating insights, denial issues, and additional documentation needs to vendor teams to facilitate corrected claim resubmission or appeal.
• Monitor appeal outcomes and denial resolution by tracking status’ via vendor workflows, AR aging reports, and payer responses to ensure claims are resolved within allowable timeframes.
• Identify and escalate trends: analyze denial pattern data across service lines, flag recurring root causes, and recommend systematic process improvements or training to mitigate future denials
• Collaborate cross-functionally: work with RCM team members and vendor personnel to address documentation or coding gaps and implement preventive corrective actions
• Maintain accurate logs of claim actions, denial codes, tasks, and outcomes; produce reports for leadership on denial trends and recovery performance.
• Ensure compliance with HIPAA, payer regulations, and internal audit standards.

POSITION REQUIREMENTS: 

• Excellent verbal and written communication skills. 
• Excellent interpersonal and customer service skills.
• Excellent sales and customer service skills.
• Excellent organizational skills and attention to detail.
• Excellent time management skills with a proven ability to meet deadlines.
• Strong analytical and problem-solving skills.
• Strong supervisory and leadership skills.
• Ability to prioritize tasks and to delegate them when appropriate.
• Ability to function well in a high-paced and at times stressful environment.
• Proficient with Microsoft Office Suite or related software.

EDUCATION AND EXPERIENCE REQUIREMENTS: 

• Minimum 3–5 years of medical AR, denial management, or revenue cycle experience—preferably in spine, orthopedics, ENT, or pain management practices.
• Proven experience reviewing eligibility, coding (CPT, ICD-10, HCPCS), modifiers, medical necessity, and authorization rules.
• Strong understanding of payer denial codes, including CARC and RARC systems.
• Skilled in analyzing aging accounts receivable, resolving underpayments, and advocating provider reimbursement.
• Proficient with denial/claim management systems, practice management or EMR platforms, spreadsheets, and payer portals.
• Exceptional analytical thinking, attention to detail, and effective communication with clinical, coding, and billing stakeholders. 

Why Join Legent Health?

Legent Health fosters an environment where team members are empowered to deliver exceptional care while growing professionally within a supportive, values-driven culture.

We Offer:

• Competitive salary and performance incentives
• Comprehensive benefits package 
• Paid time off and wellness programs
• Career development and training opportunities

Equal Employment Opportunity (EEO) Statement

Legent Health is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, disability status, or any other legally protected characteristic.

I-9 and E-Verify Compliance:
Employment eligibility will be verified through the U.S. Department of Homeland Security’s E-Verify system. All applicants must provide valid documentation to establish identity and authorization to work in the United States, as required by federal law.