Accounts Receivable Specialist

Position Summary

The Accounts Receivable Specialist is responsible for reviewing and resolving outstanding denied claims with Medicare, Medicaid and Commercial insurance companies. This included following up on claims statuses, researching rejections and denials, handling medical records request and submitting appeals within the timely filing.

Job Responsibilities

• Review insurance denials and take appropriate action.
• Check claims status via phone or portal.
• Submit Medical Records upon request and follow up on submission.
• Submit HCFA's claims to insurance companies that do not accept electronic claims.
• Submit Retros authorization
• Work closely with insurance companies to resolve claims disputes.
• Identifying and resolving billing errors and implementing processes to prevent future issues.
• Identifying and communicating process improvements to optimize revenue cycle management.
• Utilize payor portals to gather claims status information.
• Respond promptly and professionally to inquiries from insurance companies, patient, and client's representative with good customer service.
• Ensure billing practices comply with HIPAA, CMS guidelines and payor specific policies
• Communicate with insurance companies daily.
• Must meet or exceed production and quality standards.
• Review insurance rejections and make necessary corrections
• Prepare and submit appeals with supporting documentation within timely filing.
• Submit corrected claims to insurance companies.

Required Qualifications

• High School diploma or equivalent required.
• 2-4 years of experience in a related industry
• Strong understanding of Explanation of Benefits (EOBs) to determine denial reasons and appropriate actions.
• Excellent communication and interpersonal skills.
• Ability to work independently and as part of a team.
• Attention to detail and strong organizational skills.
• Strong experience using computer software, including medical billing software.
• Proficient in Microsoft Office Suite, specifically Word, Excel, Outlook, and general working knowledge of Internet for business use.
• Strong Problem-Solving skills with attention to detail.
• Strong knowledge of CPT, ICD-10
• Ability to adapt to frequent changes and manage tasks efficiently

Preferred Qualifications

• Associate's degree accounting, finance, healthcare administration, or a related field OR equivalent combination of education and experience
• 2+ year's experience in a Medical billing related position, with experience in AR
• Must possess professionalism, superior organizational skills, communications skills that allow the ability to educate and influence, an unrelenting passion for persistent follow up, and a drive towards problem resolution.
• Overall responsibility will be to follow-up on all claims from billing through final resolution and reduce delinquent accounts to achieve maximum collections from all sources.
• Drive for Results (Service, Quality, and Continuous Improvement) - Ensure procedures and processes are in place that will lead to delivery of quality results and continually reassess their effectiveness to achieve continuous improvement.
• Communication - Proficient verbal and written communication skills. Willingness to share and receive information and ideas from all levels of the organization to achieve the desired results.
• Teamwork - Commitment to the successful achievement of team and organizational goals through a desire to participate with and help other members of the team.
• Customer Service Focus - Demonstrate a focus on listening to and understanding client/customer needs and then delighting the client/customer by exceeding service and quality expectations.