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 +++.