Description

JOB SUMMARY

The Accounts Receivable Specialist is a goal-oriented, revenue-driven, highly accurate, and motivated professional. Primary duties include, but are not limited to: consistently following up on unpaid claims utilizing monthly aging reports, filing appeals when appropriate to obtain maximum reimbursement, and establishing and maintaining strong relationships with providers, clients, patients, and fellow staff. Secondary duties include but are not limited to: data entry of all patient demographic, guarantor, and insurance information, posting procedures and insurance/patient payments, and balance to daily deposits.

JOB REQUIREMENTS

Education

• High School Diploma or GED required
• Associate’s degree in Healthcare Management/Health Information Management or related field preferred

Work Experience

• 1+ years of healthcare billing accounts receivable experience in a mid to large organization - required
• 1+ years experience working in a medical office, preferred

Required Licenses/Certifications

• CPAR – Certified Patient Account Representative preferred
• Certified Medical Billing Specialist preferred

Additional Knowledge, Skills, and Abilities Required

• Hands-on knowledge of CPT and ICD codes
• Excellent phone, communication, organizational skills, computer skills, and mathematical skills
• Ability to maintain patient confidentiality

Core Competencies:

• Collaboration: Supports others and partners to work as a team. Actively listens, seeks feedback, and checks for understanding. Is a servant leader to our customers, team members, partners, and communities. Doesn't assume to always have the right answer. Creates shared success by leveraging the strengths of the entire team.
• Innovation: Embraces new ideas, processes, and tools, challenges the status quo, solves problems creatively, and strives for continuous improvement. Tests assess, adjust, and learn.
• Diversity and Inclusion: Assumes positive intent. Recognizes, values, and celebrates differences. Respect connects with and learns from each other. Actively engages others’ strengths and talents, especially when they are different. Acts think and listen without bias or prejudice.
• Courage & Integrity: Does the right thing, especially when it is difficult. Commits to organizational transparency. Promotes the truth, even when it is unpopular or controversial. Is ethical, fair, and authentic. Shares new ideas with conviction.
• Accountability: Always shows initiative, demonstrates a bias to action, and gets things done on time. Actively accepts responsibility for diverse roles, obligations, and actions that positively influence patient and customer outcomes, our partnerships, and the healthcare needs of our communities. Is specific, objective, and actionable.

Customer service skills:

• Ability to represent the Department in a professional manner when interacting with patients, guests, physicians, and their staff
• Ability to handle service issues professionally
• Ability to follow through with customers

Communication Skills:

• Ability to communicate effectively to patients about their medical conditions and the financial aspects of their care.
• Ability to manage time and balance priorities
• Organizational skills

Keyboard skills:

• Ability to type proficiently

Teamwork:

• Ability to function effectively as an extension of the Center
• Be flexible and open-minded in thought processes
• Maintain focus under pressure
• Share relevant information with other team members
• Volunteer to assist others when time permits
• Ability to work collaboratively to identify and help resolve enterprise-wide challenges

Medical Terminology & Insurance

• Knowledge of insurance guidelines for different states including Medicare, state Medicaid and workers comp.
• Knowledge of basic medical terminology
• Ability to calculate deductible and co-insurance correctly
• Ability to read and understand carrier Explanation of Benefits

Additional Knowledge, Skills, and Abilities Preferred

• Epic or eClinicalWorks experience
• Experience with Microsoft Excel and Word

ESSENTIAL FUNCTIONS

Essential functions are those tasks, duties and responsibilities that comprise the means of accomplishing the job’s purpose and objectives. Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. Following are the essential functions of the job.

• Communicate daily with Team Leaders/Section Leaders
• Provide excellent customer service in all interactions, such as when working with Patient Account Specialists, patients, payors, and center staff
• Work each account to its conclusion, including but not limited to reviewing and following up payment denials, contacting insurance carriers for payment resolution, filing appeals, submitting insurance claims to clearinghouse or individual insurance companies, retracting clams, and processing write offs and adjustments for non-payable charges according to payer contract.
• Enter information necessary for insurance claims such as patient, insurance ID, diagnosis and treatment codes and modifiers, and provider information. Insure claim information is complete and accurate.
• Prepare appeal letters to insurance carriers when not in agreement with a claim denial. Collect the necessary information to accompany the appeal.
• Check insurance payments for accuracy and compliance with contract discount
• Post insurance and patient payments using medical claim billing software.
• For patients with coverage by more than one insurer, prepare and submit secondary claims upon processing by the primary insurer. Respond to inquiries from insurance companies, patients and providers Verify patient benefits eligibility and coverage.
• Assist the Customer Service team in taking patient phone calls.
• Follows HIPAA guidelines in handling patient information.

All other duties as assigned.

Note: This job description is not inclusive of all the duties of the position. You may be asked by leaders to perform other duties. Management reserves the right to revise this position description at any time.