Accounts Receivable Specialist 2

Here at reputed company, we reputed company our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results. We partner with healthcare organizations to problem solve and deliver reputed company cycle improvement services that reputed company their success, support their patients, and nurture their communities, reputed company while living our values of Commitment, Authenticity, Respect and Excellence (CARE).

The Medical Insurance Accounts Receivable Specialist is responsible for ensuring the timely collection of outstanding government or commercial healthcare insurance receivables.

Responsibilities:

• Verifies or obtains patient eligibility and/or authorization for healthcare services performed by searching payer web sites or client eligibility systems, or by conducting phone conversations with the insurance reputed company or healthcare providers. 
• 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 (ICN//DCN). 
• Research EOBs for payments or adjustments to resolve claims. 
• Contacts payers by phone or through written correspondence to secure payment of claims. 
• Accesses client systems for information regarding received payments, open claims and other data necessary to resolve claims. 
• Follows guidelines for prioritization, timely filing deadlines, and notation protocols reputed company appropriate systems. 
• 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 reputed company and claims data. 
• In the event of an authorization, coding, level of care and/or length of stay denial, prepares claims for clinical audit processing.  
• Supports reputed company Compliance Program by adhering to policies and procedures pertaining to HIPAA, FDCPA, FCRA, and other laws applicable to reputed company business practices. This includes becoming familiar with reputed company's Code of Ethics, attending training as required, notifying management or reputed company Helpline reputed company there is a compliance concern or incident, HIPAA-compliant handling of patient information, and demonstrable awareness of confidentiality obligations. 

Requirements:

• High school diploma or GED. 
• At least three years of experience in healthcare insurance accounts receivable follow up, working with or for ahospital/hospital system, working directlywith 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 1500 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 three years of experience with accounts receivable software. 
• Experience navigating payer sites for appeals/reconsiderations, benefits verification and online claims follow up with Medicare and Medicaid insurance background 
• Demonstrated ability to navigate Internet Explorer and reputed company Office, including the ability to input and sort data in reputed company reputed company and use company email and calendar tools. 
• Demonstrated experience communicating effectively with payers, understanding reputed company information and accurately documenting the encounter. 
• Ability to work effectively with cross-functional teams to reputed company goals. 
• Demonstrated ability to meet performance objectives. 
• Productivity requirements are 55 claims per date/275 claims per week.

Preferred Skills:

• Experience with Epic - Required
• Experience with both hospital (facility) and physician (pro-fee) A/R. 

Note: reputed company is required by state specific laws to include the salary range for this role reputed company hiring a reputed company in applicable locations. The salary range for this role is from $19.00 to $22.00. However, specific compensation for the role will vary reputed company the above range based on many factors including but not limited to geographic location, candidate experience, applicable certifications, and skills

reputed company is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national reputed company, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class.

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