CERTIFIED ACCOUNTS RECEIVABLE SPECIALIST

Overview

The Certified Accounts Receivable Specialist is responsible for pursuing reimbursement of services rendered and achieving accounts receivable resolution. This role involves resolving insurance carrier denials, appealing claims, contacting carriers regarding open accounts, and responding to insurance carrier correspondence and inquiries while demonstrating flexibility with assignments within professional scope / duties / licensure. The specialist will work with various payers, including Medicare, Medicaid, and commercial insurers, ensuring compliance with all relevant regulations.

Essential Duties

Claims Management & Resolution :

• Consistently meet or exceed productivity and quality standards for claim edits, complaint claim submissions, and clinical documentation requirements.
• Ensure timely filing of claims, resulting in clean, complete, and accurate submissions.
• Perform timely follow-up on denials and appeals, including root cause analysis to reduce / prevent future denials while working to overturn denials for payment resolution.
• Submit specialist provider appeals denied for medical necessity, coding / bundling issues, experimental, and technical reasons.

Coding & Charge Corrections :

Payer Interaction & Compliance :

Reporting & Analysis :

Customer Service & Support :

Responsibilities

Preferred Experience

Required Licensure / Education

Employee Health Requirements

Exposure / Sensory Requirements

Exposure to : Chemicals : None

Video Display Terminals : Extreme

Blood and Body Fluids : None

TB or Airborne Pathogens : None.

Sensory requirements (speech, vision, smell, hearing, touch) :

Speech : Needed for presentations / training, telephone communication, facilitate meetings.

Vision : Needed to read memos and literature.

Smell : N / A

Hearing : Needed for telephone communications, meetings, and listening to employee concerns.

Touch : Need to write, do computer entry, filing.

Activity / Lifting Requirements

Percentage of time during the normal workday the employee is required to :

Sit : 85%

Twist : 0%

Stand : 5%

Crawl : 0%

Walk : 5%

Kneel : 0%

Lift : 2%

Drive : 0%

Squat : 1%

Climb : 0%

Bend : 1%

Reach above shoulders : 1%

The weight required to be lifted each normal workday according to the continuum described below :

Up to 10 lbs : Occasionally

Up to 20 lbs : Occasionally

Up to 35 lbs : Not Required

Up to 50 lbs : Not Required

Up to 75 lbs : Not Required

Up to 100 lbs : Not Required

Over 100 lbs : Not Required

Describe and explain the lifting and carrying requirements. (Example : the distance material is carried; how high material is lifted, etc.) : Lifting is not usually required.

Maximum consecutive time (minutes) during the normal workday for each activity :

Sit : 408

Twist : 0

Stand : 24

Crawl : 0

Walk : 24

Kneel : 0

Lift : 9

Drive : 0

Squat : 8

Climb : 0

Bend : 8

Reach above shoulders : 4

Repetitive use of hands (Frequency indicated) :

Simple grasp up to 10 lbs. Normal weight : 5- 10# frequent

Pushing & pulling Normal weight :

Fine Manipulation : Terminal entry, calculator.

Repetitive use of foot or feet in operating machine control : None

Environmental Factors &Special Hazards

Environmental Factors (Time Spent) :

Inside hours : 40

Outside hours : 0

Temperature : Normal Range

Lighting : Average

Noise levels : Average

Humidity : Normal Range

Atmosphere : Dust &Poor Ventilation

Special Hazards : None

Protective Clothing Required : None

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our Commitment to You :

Riverside Healthcare offers a comprehensive suite of Total Rewards : benefits and nationally rated employee well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so your journey at and away from work is remarkable. Our Total Rewards package includes :

Compensation

Benefits and more

Pay Range

USD $24.12 - USD $29.50 / / Hr