The Accounts Receivable (AR) Specialist is responsible for supporting the Revenue Cycle Team with insurance accounts receivable. Responsible for reviewing all assigned accounts within a timely manner, maintaining metrics that fall within the expectations set by organizational leadership and based on national benchmarks. Must maintain a comprehensive understating of the health insurance market, specific plan requirements, and standard payment options. Required to communicate with assigned region(s), team members, and third parties such as insurance companies, in a way that is perceived as thorough and clear. Responsible for researching missing insurance payments and collecting appropriate documentation to recording transactions in the practice management system.
Key Responsibilities:
- Communication: Must have professional and timely communications to practices and other Revenue Cycle teams.
- AR Follow-Up: Work assigned aging reports to ensure timely payments, fee schedule disputes, and cash posting is accurate. Identify claim denials and payment trends on claims.
- Secondary Claims Processing: Initiate the accurate and timely processing of all secondary claims, as needed.
- Audit patient ledgers for correct charge posting payments, contracted amounts, and adjustments.
- Denied Claims: Work denied and rejected claims and resubmit claims for reimbursement to the insurance companies for appropriate reimbursement; contest charges that are not paid or underpaid with the insurance carrier. If claim is denied, ensure correct denial code is used.
- Appeals: Complete all claim appeals according to payer specific, timely-filing guidelines; reviews clinical documentation for appeals and composes detailed formal appeal letters for payment or contacts provider for appeals letter.
- Adjustments/Write-Offs: Ensure policies are being followed according to company guidelines; audit accounts prior to making any adjustments or write-off; ensure correct adjustment or write-off codes are used.
- Performs other duties as assigned from time to time.
Qualifications:
- 2+ years’ experience in Revenue Cycle working accounts receivable
- Experience reading explanation of benefits and communicating with Insurance plan representatives.
- Strong knowledge of Microsoft Office Suite products; specifically, Excel, Work, and Outlook.
- High School Diploma
- Knowledge of medical insurance and terminology
- Strong analytical, critical thinking and problem-solving skills
- Strong interpersonal and communications skills to be able to work successfully in a team-oriented environment.
