ACCOUNTS RECEIVABLE SPECIALIST - Full Time

Responsibilities

Come and join the RMC Family!

We have been in the community since 1935.  Our mission is to provide comprehensive multi-specialty medical services in the greater Riverside region.  Your passion, inspiration, and talents are invaluable to us and our mission to serve others.  Our facility can provide a place for you to thrive and continue your professional development.  Quality Healthcare is our passion, improving lives is our reward.  We are working to change lives and transform the delivery of healthcare. Riverside Medical Clinic is the best place to work, practice medicine, and receive care.

SUMMARY :  Responsible for the accurate and timely processing of fee-for-service claims and account collections.

QUALIFICATIONS :  To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Qualifications

EDUCATION and / or EXPERIENCE :  High school diploma or general education degree required. Knowledge of medical terminology required. Two years prior experience in medical billing / collections is REQUIRED.

CERTIFICATES, LICENSES, AND REGISTRATIONS :  None.

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. Note : Other duties may be assigned, deleted or changed at any time, at the discretion of management, formally, or informally, either verbally or in writing.

1. Assist the supervisor as requested.

2. Review, adjust, and / or mail out all assigned tracer claims

3. Initiate claim review and / or appeals, as indicated on assigned explanation of benefits.

4. Review, adjust, and / or process all assigned correspondence.

5. Work aging AR :

a. Contact insurance carrier to check on claim status and / or responsible party to settle account.

b. Review Explanation of Medical Benefits to verify accuracy of reimbursement

c. Verify insurance coverage

d. Initiate necessary account adjustments, change of charges and / or refunds as indicated.

6. Analyze and investigate denied claims to determine the root cause of denials, including coding errors, missing information, and billing discrepancies.

7. Prepare and submit appeals for denied claims, utilizing a comprehensive understanding of payer requirements and regulations to maximize the likelihood of successful resolution.

8. Resubmit corrected claims with the appropriate documentation and follow up to ensure timely processing.

9. Communicate with insurance companies, payers, and other relevant parties to resolve denials and obtain information needed for appeals and / or resubmission.

10. Maintain regular follow-up with insurances and responsible parties to track the progress of appealed claims and pending actions. Escalate as necessary to achieve successful resolution.

11. Stay informed about industry changes, billing regulations, and payer policies to ensure compliance with applicable laws and best practices.

12. Manage and resolve claims with pending responses from insurance companies and / or other parties.

13. Track and follow up on unpaid claims and / or incomplete documentation.

14. Review account with no response and communicate with relevant parties to obtain necessary information

15. Document all interactions and actions taken.

16. Display a professional attitude through performance, appearance, and demeanor.

This opportunity offers the following :

Challenging and rewarding work environment

Growth and Development Opportunities within UHS and its Subsidiaries

Competitive Compensation

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.  www.uhs.com

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Avoid and Report Recruitment Scams

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.