The Account Receivable Specialist prepares and processes medical insurance claims and is responsible for the resolution of any balances that remain for outstanding medical claims.
This is accomplished by follow up via phone, website, or written correspondence with both internal and external stakeholders.
Responsibilities:
Efficiency
Reviews medical insurance claims to ensure that revenue recognition is accurate.
Creates and processes claims submission for various payers in a timely manner per payer guidelines.
Promptly reviews accounts receivable, daily, and performs follow -up on delinquent accounts according to established policies and procedures. Recommends departmental/agency corrective action as required.
Conducts analysis of denials and partial payments to determine trends that may need to be addressed either in revenue cycle management, operationally, or with the payer.
Quality
Conducts thorough research of claim status to identify issues, documents action taken on the claim and implements corrective measures to obtain payment and ensure accuracy of future claim submissions.
Receives, investigates, and responds to inquiries from payors and/or agencies concerning accounts receivable activity according to established policies and procedures on a regular basis.
Maintains and develops accounts receivable issues and resolution tracking for ease of reporting.
Works in coordination with service locations to obtain information needed for clean claim submission and additional follow up documentation as needed.
Meets and strives to exceed the productivity metrics as outlined in policy.
Meets and strives to exceed the quality metrics as outlined in policy.
People
Communicates effectively with leadership, teammates, operations and customers.
Expediently resolves all customer requests, inquiries, and concerns.
Ability to work collaboratively in a continuously changing environment with a spirit of cooperation and professionalism.
Problem solves independently before referring issues to the Supervisor/Manager for resolution.
Service
Meets work schedule and attendance expectations.
Performs similar, comparable, or related duties as may be required or assigned.
Completes special projects and other assignments, as deemed necessary.
Qualifications:
Education and Experience:
Formal Education:
High School Diploma or equivalent
Experience:
1-year medical billing and collections experience, preferred.
Revenue cycle experience desired.
Skills Requirements:
Ability to learn a variety of systems and maneuver through them daily, including electronic medical record systems, clearinghouse systems, and carrier systems.
Excellent problem-solving skills and the ability to handle multiple tasks simultaneously.
Ability to work independently and prioritize responsibilities daily to complete all assignments timely and accurately.
Strong computer skills with Microsoft Office knowledge and experience.
Ability to work in a fast-paced, continuously changing environment.
Ability to recognize roadblocks that may be causing slower reimbursement and work with management team to create solutions.
Superior customer service and written/verbal communication skills.
Must be able to meet work schedule and attendance expectations.
