AR Specialist

About Our Company: At Infinx, we're a fast‑growing company focused on delivering innovative technology solutions to meet our clients' needs. We partner with healthcare providers to leverage automation and intelligence, overcoming revenue cycle challenges and improving reimbursements for patient care. Our clients include physician groups, hospitals, pharmacies, and dental groups. We're looking for experienced associates and partners with expertise in areas that align with our clients' needs. We value individuals who are passionate about helping others, solving challenges, and improving patient care while maximizing revenue. Diversity and inclusivity are central to our values, fostering a workplace where everyone feels valued and heard. A 2025 Great Place to Work In 2025, Infinx was certified as a Great Place to Work in both the U.S. and India, underscoring our commitment to fostering a high‑trust, high‑performance workplace culture. This marks the fourth consecutive year that Infinx India has achieved certification and the first time the company has earned recognition in the U.S. Location: Remote or Hybrid in New Orleans, LA Summary Description The Revenue Cycle Specialist is a hands‑on, cross‑functional operator capable of working directly within client EHR and billing systems to execute the full lifecycle of a claim from eligibility verification and demographic accuracy through direct claim submission, edit resolution, and AR follow‑up to final account resolution. Candidates must be experienced working natively in client source systems and must be capable of billing claims directly to payers including Medicare DDE/FISS, state Medicaid portals, and payer‑specific direct submission channels. Job Responsibilities Flex across assigned functional areas (eligibility, demographics, billing, edit resolution, AR follow‑up, and denial management) based on client volume, priority, and engagement need Verify active insurance coverage and benefits using payer portals, EDI 270/271 transactions, and direct payer outreach; document coverage details including effective dates, plan type, network status, copays, deductibles, coinsurance, and benefit limitations Determine primary, secondary, and tertiary payer order in accordance with coordination of benefits rules; identify Medicare Secondary Payer, workers' compensation, motor vehicle accident, and third‑party liability scenarios Flag services requiring prior authorization, pre‑certification, or referral and route to the appropriate team Review, correct, and validate patient demographic, guarantor, subscriber, and insurance plan data in the EHR, PMS, or registration system; resolve demographic‑related rejections and registration errors at the root Submit clean claims directly to payers via Medicare DDE/FISS, state Medicaid portals, and payer‑specific direct submission channels, working natively in client EHR and billing systems rather than exclusively via clearinghouse Resolve front‑end claim edits, scrubber rejections, and pre‑submission errors at the source system level, including demographic, eligibility, payer ID, modifier, diagnosis, and revenue code corrections Interpret and resolve NCCI procedure‑to‑procedure edits, MUE edits, LCD/NCD policy edits, and bundling logic Correct UB‑04 and CMS‑1500 field‑level data including revenue codes, HCPCS, occurrence/conditions/value codes, modifiers, place of service, and rendering provider information as applicable Work aged accounts receivable, prioritizing high‑dollar and high‑aging balances to maximize cash collections Contact payers via phone, portal, and electronic inquiry to determine claim status, identify denial or pending reasons, and drive claims toward payment Research and resolve claim denials and underpayments by identifying root causes and taking corrective action (rebilling, reconsiderations, appeals, corrected claims, medical records submission) Prepare and submit written appeals with supporting clinical documentation, operative reports, and payer policy references Identify and pursue underpayments by comparing actual reimbursement against expected contract terms Manage payer follow‑up across all payer classes including Medicare (Traditional and Advantage), Medicaid, commercial, managed care, workers' compensation, TRICARE, and VA Analyze rejection and denial trends to identify systemic issues and elevate data‑driven recommendations to leadership Collaborate with coding, charge capture, patient access, HIM, and client‑side teams to resolve upstream issues impacting claim payment Document all account activity with clear, concise, and actionable notes in the source system Maintain productivity and quality standards in a high‑volume, deadline‑driven, metrics‑oriented environment Maintain full compliance with HIPAA, payer guidelines, CMS regulations, and federal/state billing regulations at all times Assignments may shift across functional areas based on client needs and individual strengths within the scope of the revenue cycle Skills and Education High School Diploma or GED CRCR (Certified Revenue Cycle Representative) or CRCS (Certified Revenue Cycle Specialist) certification preferred 3‑5 years of hospital and/or physician revenue cycle experience in at least two of the following: eligibility/benefits verification, demographic/registration data integrity, billing and claim edit resolution, AR follow‑up, and denial management 6+ years of cross‑functional hospital revenue cycle experience covering all five focal areas (eligibility, demographics, billing, rejections/edits, AR follow‑up) preferred Hands‑on experience submitting claims directly to payers via Medicare DDE/FISS, state Medicaid portals, and/or payer‑specific direct submission channels, not exclusively via clearinghouse Experience with Medicare FISS/DDE direct submission and adjustment workflows preferred Familiarity with both facility (UB‑04) and professional (CMS‑1500) claim types preferred Experience with credit balance resolution, underpayment recovery, or contract variance analysis preferred Prior experience in a healthcare outsourcing or multi‑client environment with client‑specific SLA and productivity targets preferred Demonstrated ability to work natively in client EHR, PMS, and billing systems rather than only in clearinghouse or proprietary mid‑layer platforms Comprehensive knowledge of UB‑04 and CMS‑1500 claim forms, revenue codes, CPT/HCPCS, ICD‑10‑CM, and modifier usage Expertise in major payer processes including Medicare, Medicaid, TRICARE, VA, and commercial payers Working knowledge of NCCI edits, MUE edits, LCD/NCD policy logic, and bundling rules Hands‑on experience with major payer portals (Availity, NaviNet, UHC, Aetna, Cigna, Anthem, Medicare MAC portals, state Medicaid portals) and EDI 270/271 eligibility transactions Knowledge of coordination of benefits, primary/secondary/tertiary payer determination, and Medicare Secondary Payer rules Strong analytical skills to interpret EOBs, remittance advices, contracts, and payment documentation Solid Excel skills (filtering, sorting, pivot tables, basic formulas) and comfort working across multiple systems simultaneously Ability to establish and maintain effective working relationships with team members, supervisors, managers, clients, and providers Ability to prioritize workload and manage multiple responsibilities in a highly organized, efficient, and effective manner Knowledge of HIPAA, billing compliance, CMS regulations, and fraud/abuse regulations Bilingual (English/Spanish) for patient‑facing communication preferred Company Benefits and Perks Joining Infinx comes with an array of benefits, flexible work hours when possible, and a genuine sense of belonging to a dynamic and growing organization. Access to a 401(k) Retirement Savings Plan. Comprehensive Medical, Dental, and Vision Coverage. Paid Time Off. Paid Holidays. Additional benefits, including Pet Care Coverage, Employee Assistance Program (EAP), and discounted services. If you are a dedicated and experienced Revenue Cycle Specialist ready to contribute to our mission and be part of our diverse and inclusive community, we invite you to apply and join our team at Infinx. #J-18808-Ljbffr