The Accounts Receivable Specialist is responsible for ensuring all eligible accounts are reviewed, appealed, escalated or adjusted within the designated payer timeframes and are documented appropriately in the patient accounting system. Additionally, the AR representative will be responsible for the tracking and trending of recovery efforts by utilizing various departmental tools and appropriately reporting on-going problems specific to payers, health system departments, and/or contracts. The AR representative will work closely with other team members to ensure necessary communication and feedback to the department.

Duties and Responsibilities

• Execute the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party payers. Research and resolve payer rejected/denied claims and analyze accounts for insurance payment accuracy/completeness and for payer claim processing accuracy per contract. Work with clinical staff as needed to follow-up and appeal denials.
• Appropriately report on-going problems specific to payors.
• Appeal in accordance with methodology in departmental policy and procedure including using correct grammar and spelling.
• Transmit required documentation to Government and third-party payers for the purpose of resolving payments.
• Ensure claims are crossed over to secondary insurances, reporting any delay in unbilled secondary claims to your Lead.
• Consistently meet the current productivity standards in addressing and resolving accounts.
• Consistently meet the current quality standards in taking appropriate actions to identify and track root causes, successfully appeal denied accounts, and trend issues.
• Perform any other duties as assigned by leadership.

Qualifications:

Must have a combination of education and experience within the field of healthcare revenue cycle including knowledge of commercial, Medicare, Medicaid, VA, Tricare and Worker’s Comp payers. Insurance Follow-up required and Billing knowledge is a plus.

Required Minimum Skills:

• Experience with Anesthesia billing and follow-up is a plus however, it is not a requirement

• Ability to problem-solve & troubleshoot insurance claim

• Working knowledge of Managed Care, Medicare and Medicaid

• Knowledge of Word and Excel

• Detail-oriented

• Focused on achieving personal, team and company goals