Insurance & Patient AR Specialist

Insurance & Patient AR Specialist

The Insurance & Patient AR Specialist is tasked with overseeing all aspects of medical accounts receivable collections for a physician medical group. They hold responsibility for following up on claim denials from all assigned insurance payers, resolving billing issues, and addressing inquiries from patients and clinic staff. Utilizing effective collection techniques, the Billing Specialist ensures that accounts receivable remain current, actively monitoring for delinquent payments and taking appropriate actions to rectify such instances. In addition, you will be responsible for contributing to the growth and success of HealthTexas while upholding our Mission, Vision and Values.

Culture and Values Expectations

At HealthTexas, we believe that our workplace culture is the cornerstone of our success. We are committed to fostering an inclusive, collaborative, and innovative environment where every Associate feels valued, empowered and motivated to reach their full potential. Our culture is the driving force behind our mission "to deliver quality and compassionate care with outstanding service, every patient, every time". As a Billing Specialist at HealthTexas we expect you to embody and promote our Values and defined behavioral expectations.

• Integrity: Do the right thing, the right way, every time. Be honest and uphold commitments and responsibilities, earn the trust and respect of the team and those we serve, and maintain privacy and confidentiality.
• Compassion: Treat everyone with respect and dignity. Foster an environment of inclusivity and well-being, practice patience and empathy, and assume positive intent.
• Synergy: Collaborate to improve outcomes. Invite and explore new opportunities, promote effective communication and teamwork, take pride in yourself, your work and HealthTexas.
• Stewardship: Use resources responsibly and efficiently. Implement effective strategies to attain goals, achieve maximum productivity and results, and seek continuous knowledge and improvement.

Essential Job Duties & Responsibilities

• Follows up on insurance billing to ensure prompt receipt of payments.
• Demonstrates professionalism in interactions with patients and insurance companies regarding sensitive financial matters, actively working to recapture unpaid balances.
• Receives and resolves patient billing inquiries promptly, initiating adjustment requests as necessary to address any discrepancies.
• Proactively follows up on all zero payment explanations of benefits, exploring all available options to obtain claim payments.
• Conducts monthly reviews of assigned accounts, identifying inconsistencies and correcting errors as needed, ensuring accuracy.
• Provides comprehensive support for inquiries related to accounts, offering assistance and guidance to stakeholders.
• Conducts thorough research on billing issues and follows up with all relevant parties to achieve resolution.
• Initiates payer and/or patient refund requests for overpayments after conducting necessary research to validate the refund eligibility.
• Initiates debt write-off requests in accordance with established policies and procedures, adhering to regulatory guidelines.
• Other duties as assigned.

Experience

• 2+ years medical billing and/or collections experience in a physician's or other medical facility setting
• Must be able to multi-task, meet deadline and be a team player

Education

• High School Diploma or GED
• Completion of a recognized course of study for billing and coding is preferred.

Knowledge, Skills & Abilities

• Knowledge of governmental insurance plans (Medicare Part B and C, Medicaid and associated advantage plans, Tricare, etc.) and commercial insurances (PPO, HMO, EPO, HRA, etc.)
• Working knowledge of CPT, HCPCS, and ICD-10
• Understanding of HIPPA guidelines
• Working knowledge of Word, Excel, and Outlook
• Experience with EMR software (eClinicalWorks preferred, but not required)

Work Hours, Travel Requirements

• Monday Friday, 8:00 a.m. 5:00 p.m., and as needed to complete projects.
• Travel to medical offices may be necessary for the purpose of providing benefit education.

Working Conditions & Physical Requirements

• This job operates in an office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, scanners, filing cabinets and fax machines.
• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. This is largely a sedentary role; however, some filing is required. This would require the ability to lift files, open filing cabinets and bend or stand on a stool as necessary. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.