Accounts Receivable Specialist

October 14

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Revenue Cycle Management • HIM • Patient Engagement • Revenue Integrity • Accounts Receivable Management

1001 - 5000

Description

• Responsible for ensuring timely collection of outstanding government or commercial healthcare insurance receivables. • Verifies or obtains patient eligibility and/or authorization for healthcare services. • Updates patient demographics and/or insurance information in appropriate systems. • Conducts research and appropriately statuses unpaid or denied claims. • Monitors claims for missing information, authorization, and control numbers. • Research EOBs for payments or adjustments to resolve claims. • Contacts payers to secure payment of claims. • Accesses client systems for information regarding received payments and open claims. • Follows guidelines for prioritization, timely filing deadlines, and notation protocols. • Secures medical documentation as required or requested by third party insurance carriers. • Obtains billing guidelines and requirements by researching provider billing manuals. • Writes appeal letters for technical appeals. • Verifies accuracy of underpayments by researching contracts and claims data. • Prepares claims for clinical audit processing in case of denials.

Requirements

• High school diploma or GED. • At least two years of experience in healthcare insurance accounts receivable follow up, working with or for a hospital/hospital system, working directly with government or commercial insurance payers. • Experience identifying billing errors and resubmitting claims as well as following up on payment errors, low reimbursement and denials. • Experience reviewing EOB and UB-04 forms to conduct A/R activities. • Knowledge of accounts receivable practices, medical business office procedures, coordination of benefit rules and denial overturns and third-party payer billing and reimbursement procedures and practices. • At least two years of experience with accounts receivable software. • Experience navigating payer sites for appeals/reconsiderations, benefits verification and online claims follow up. • Demonstrated ability to navigate Internet Explorer and Microsoft Office, including the ability to input and sort data in Microsoft Excel and use company email and calendar tools. • Demonstrated experience communicating effectively with payers, understanding complex information and accurately documenting the encounter. • Ability to work effectively with cross-functional teams to achieve goals. • Demonstrated ability to meet performance objectives. • Productivity requirements are 45 claims per date/225 claims per week.