Receivables Resolution Specialist

Purpose of Position

Perform accurate and timely account resolution.

Description

1. Perform accurate and timely follow-up, reconciliation and resolution of outstanding account balances.

2. Analyze and resolve outstanding receivables utilizing remittance reports, payment advisories, explanation of benefits, etc.

3. Verify accuracy of third party payments.

4. Post contractual allowances where necessary.

5. Refer accounts for billing where appropriate, reassign eligible balances to self-pay and / or 3rd party billing status.

6. Process third party payor denials and related correspondence in a timely and accurate manner.

7. Perform administrative and clerical functions including but not limited to typing, photo copying, filing, calculating, faxing, etc., as assigned.

8. Collaborate and interact with all departments to resolve edit errors.

9. Maintain job knowledge adequate to effectively carry out the responsibilities of assigned insurance (s) group including CPT, HCPC, occurrence, condition, span and value codes in addition to modifiers.

10. Maintain supporting documentation for all account changes with originating department sign-off.

11. Pursue other insurance information through eligibility verification and check claims status utilizing online access and individual insurance carrier websites.

12. Review billing, payment, and denial information utilizing a number of automated databases.

13. Identifies potential reason(s) for payment denial, initiates and follows through with appropriate remedial action.

14. Utilize third party denial management system to provide reports and workflow denials.

15. Perform follow-up activities on unpaid accounts through downloaded trial balances, internet insurance websites, and other reports and / or claim listings where appropriate.

16. Perform individual claim correction, adjustments, and cancels through online access to specific payors websites.

17. Calculate patient liability and perform system adjustments to support accurate patient statement billing as needed.

18. Respond to patient and / or insurer inquiries in a professional, timely, efficient and knowledgeable fashion, ensuring HIPAA and CCHC guidelines are followed.

19. Monitor credit balance reports and performs analysis making appropriate claims adjustments and / or refunds as necessary.

20. Create and maintain logs and reports as needed to support Patient Account activities.

21. Assists the department and acts as a team member by covering for absences, training activities, etc., in support of hospital and departmental work activities.

22. Comply with departmental and organizational policies including but not limited to dress code, use of supplies, phones and computers.

23. Adheres to work schedules and maintains a safe and orderly work area at all times, maintaining awareness of and compliance with safety policies and procedures.

24. Attends and participates in educational programs, in-service meetings, workshops, and other activities as related to job performance, job knowledge and state regulations.

25. Ability to analyze automated computer output.

26. Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers.

27. Performs other job related duties and assignments as requested.

Qualifications

• Ability to read, write and communicate in English.
• Ability to work independently in a high paced and high demand environment or setting.
• High School diploma or GED required.
• 12 months experience in accounts receivable, third-party medical billing or revenue cycle OR successful passage of the Patient Financial Services Qualifying Test.
• Successful passage of basic Medical Terminology course OR successful passage of the CCHC Medical Terminology exam.
• PC skills, including Microsoft Excel, Word and Outlook.
• Experience in a healthcare setting preferred; prior healthcare / hospital experience with knowledge of EPIC or other hospital patient accounting system preferred.