Accounts Receivable Specialist

Position Summary

The Accounts Receivable Specialist performs resolution oriented activities with a focus on comprehensive medical billing, payment posting, and / or collection actions.  While ensuring compliance with relevant laws, regulations and established company policies and compliance programs this role is responsible for efficient cash collections through excellent reimbursement practices, accurately posting of EFT, credit card, ACH and check insurance / patient payments, and / or performing accurate claim billing.

Essential Duties and Responsibilities

The essential functions may include, but are not limited to the following :

• Supports and / or performs daily duties as assigned in one or multiple areas of the department which include :
• Payment Posting : EFT, credit card, ACH, live check and insurance payments
• Researches and evaluates insurance payments and correspondence for accuracy
• Accurate processing and posting of insurance and patient payments
• Matches EOB and payment records with payments
• Processing write offs according to company policy
• Batching and scanning of payments to ensure records are on file
• May assist with administrative duties fundamental to successful posting or project operations
• Billing : Accurate and timely submission of all claims for all payers
• Daily claim / invoice submission for primary, secondary and tertiary payers and / or patient statements
• Review rejected claims, perform correction activities and ensure resubmission as appropriate
• Ensure all Contract Billing Partner billing is submitted to appropriate outsourced partner
• Collections : Timely and accurate follow up on unpaid claims or patient accounts
• Work assigned lists of outstanding claim balances and / or patient accounts with multifaceted issues across different payers and patients
• Identify trends, conduct follow up and perform root cause analysis on unpaid and underpaid insurance claims across different payers
• Analyze and resolve billing discrepancies on patient accounts. Ability to explain findings to patient
• Use persuasive written and oral communication skills to draft appeals and effectively overturn denied or underpaid claims
• Perform actions towards remediation of outstanding balances according to policy and procedure; including but not limited to, in depth research appeals, rebilling, calling the payer or clinic, and utilizing payer portals
• Identify and communicate issues or trends to department management ensuring consistent and efficient department process
• Ensure adherence with federal regulatory timeframes for handling cases including acknowledging cases, resolving cases, monitoring effectuation of resolution, completing resolution letters and communicating with members and providers within required time frames
• Work collaboratively within the team and with other departments
• Be a positive role model willing to share knowledge, skills and expertise with all members of the team
• Comply with all HIPAA and privacy regulations
• Adhere to laws and best practices in regards to dealing with patients and patient data
• Perform other job-related duties as assigned

Minimum Qualifications (Knowledge, Skills, and Abilities)

Physical Demands and Work Environment

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions.