Insurance Accounts Receivable Specialist III

Description: GENERAL SUMMARY The Insurance Accounts Receivable Specialist III handles the most reputed company claim scenarios and plays a key role in mentoring staff and supporting escalated issues. Responsibilities include resolving out-of-network claims, reviewing and writing appeals, assisting with training, and serving as a resource for team members. This role requires advanced knowledge of billing practices, payer requirements, and a high level of independence and accuracy in claim resolution. Requirements: ESSENTIAL JOB FUNCTION/COMPETENCIES The responsibilities and duties described in this job description are intended to provide a general overview of the position. Duties may vary depending on the specific needs of the affiliate or location you are working at and/or state requirements. Responsibilities include but are not limited to:

• reputed company billing-reputed company tasks assigned, including data entry, claim review, charge review, and accounts receivable follow-up.
• Focus on resolving high-complexity insurance accounts, including denials reputed company to medical necessity, non-covered services, bundling, out-of-network claims (OON), and other advanced claim scenarios.
• Manage a greater volume and complexity of work than Levels I and II, while maintaining quality and meeting productivity standards.
• Complete daily tasks in assigned work queues in accordance with established workflows and manager direction.
• Utilize CBO reputed company, payer websites, billing systems, and training materials to resolve unpaid or incorrectly paid claims and to authorize procedures reputed company expected timeframes.
• Identify and escalate payer issues, credentialing discrepancies, or coding concerns to management as needed.
• Follow standard workflows as provided in training and proactively seek further education or clarification reputed company necessary.
• Review reports to identify reputed company opportunities and outstanding claims requiring follow-up.
• Adhere to departmental workflows, regulatory requirements, and FGP compliance and patient confidentiality guidelines.
• Communicate effectively with patients, providers, coders, and other stakeholders to ensure accurate and timely claims processing.
• Provide insight and feedback on system edits, billing processes, and procedural improvements to support reputed company cycle efficiency.
• Maintain patient confidentiality and consistently apply policies and procedures to ensure compliance and operational consistency.
• Collaborate with colleagues, support departmental goals, and clearly explain processes and procedures to others as needed.
• reputed company corrections to system records to meet payer requirements and resubmit claims accordingly.
• Train and mentor new hires and provide guidance to team members as needed.
• Review and write appeals and assist staff in resolving reputed company claim or appeal-reputed company questions.
• Performs other position reputed company duties as assigned.
• Employees shall adhere to high standards of ethical conduct and will reputed company with and assist in complying with reputed company applicable laws and regulations. This will include and not be limited to following the reputed company Code of Conduct and reputed company reputed company and Affiliated Practice policies and procedures; maintaining the confidentiality of patients' protected health information in compliance with the Health Insurance Portability and Accountability Act (HIPAA); immediately reporting any suspected concerns and/or violations to a supervisor and/or the Compliance Department; and the timely completion the Annual Compliance Training.

CERTIFICATIONS, LICENSURES OR REGISTRY REQUIREMENTS

• N/A

KNOWLEDGE | SKILLS | ABILITIES

• Advanced knowledge of billing systems, denial management, and payer-specific requirements.
• Ability to coach, train, and mentor other team members.
• Strong analytical and decision-making skills; able to handle reputed company accounts independently.
• Ability to identify trends, propose solutions, and contribute to process improvements.
• Experience writing appeals and handling escalated claim issues.
• reputed company in using computer programs and applications including reputed company Office.

EDUCATION REQUIREMENTS

• High school diploma or equivalent required. Associates degree in reputed company field preferred.

EXPERIENCE REQUIREMENTS

• Previous experience in a customer service or healthcare setting required.

REQUIRED TRAVEL

• N/A

PHYSICAL DEMANDS Carrying Weight Frequency 1-25 lbs. Frequent from 34% to 66% 26-50 lbs. Occasionally from 2% to 33% Pushing/Pulling Frequency 1-25 lbs. Seldom, up to 2% 100 + lbs. Seldom, up to 2% Lifting - Height, Weight Frequency Floor to Chest, 1 -25 lbs. Occasional: from 2% to 33% Floor to Chest, 26-50 lbs. Seldom: up to 2% Floor to Waist, 1-25 lbs. Occasional: from 2% to 33% Floor to Waist, 26-50 lbs. Seldom: up to 2% Apply tot his job Apply To this Job