AR Specialist

Job Description:

• Perform timely follow-up on California Medicare, Commercial, and Workers’ Compensation claims to ensure prompt adjudication
• Conduct direct outreach to commercial payers, Medicare contractors, WC adjusters, case managers, and employers to obtain claim status, authorization verification, and documentation requirements
• Resolve claim rejections, underpayments, incorrect fee schedule applications, and missing documentation across payer types
• Track and manage Workers’ Compensation payer-specific timelines, including 30-day status cycles and state-mandated payment rules
• Monitor claims for timely filing, medical necessity, eligibility discrepancies, coordination of benefits, and modifier accuracy
• Coordinate with authorization teams to confirm authorization validity and ensure required documentation is submitted prior to billing
• Escalate delayed or complex cases to appropriate internal team members or external partners
• Identify opportunities for appeal when claims are underpaid or incorrectly denied
• Prepare and submit appeal letters, reconsideration requests, and supporting documentation
• Identify and report recurring denial trends and collaborate with billing, coding, and authorization teams to prevent recurrence
• Assume other responsibilities as appropriate to the position and organizational needs
• Support Boomerang Healthcare’s revenue cycle management operations for multidisciplinary pain-care services

Requirements:

• High school diploma or GED required
• 3+ years of AR follow-up experience with strong emphasis on California Medicare and Commercial billing
• Working knowledge of Workers’ Compensation billing, including adjuster communication, state rules, medical necessity, and required documentation
• Experience managing mixed payer AR inventories with competing timelines and requirements
• Ability to work in a fast-paced environment, meet daily deadlines, and collaborate with cross-functional RCM teams
• Experience with multiple EHR / Practice Management systems (IMS, NextGen, Athena, eClinicalWorks, or similar)
• Basic understanding of NCCI edits and payer-specific billing guidelines
• Strong verbal and written communication skills; excellent attention to detail
• Advanced proficiency in Microsoft Excel (formulas, pivot tables) and solid skills in other Microsoft Office applications
• Must be available Monday-Friday, 8am-5pm
• Must work 40 hours per week

Benefits:

• Amazing work/life balance
• Generous Medical, Dental, Vision, and Prescription benefits (PPO & HMO)
• 401(K) Plan with Employer Matching
• License & Tuition Reimbursements
• Paid Time Off
• Holiday Pay & Floating Holiday
• Employee Perks and Discount Programs
• Supportive environment to help you grow and succeed
• Remote work arrangement