Accounts Receivable Specialist - Hospital

SUMMARY: Knowledgeable in Medicare, Medicaid, Worker’s Compensation and Third Party Payer claim processing. Knowledgeable in bookkeeping, computer skills as related to claims processing, possess organizational skills and the ability to work independently.

ESSENTIAL DUTIES AND RESPONSIBILITIES: (as assigned) 

• Demonstrates knowledge and ability to follow medical billing practices.
• Demonstrates knowledge of Level I Healthcare Common Procedure Coding Systems (HCPCS) comprised of Current Procedural Terminology (CPT-4) and International Classification of Diseases (ICD) codes.
• Demonstrates knowledge of Medicare, Medicaid, Insurance Managed Care Plans and Workmen’s Compensation.
• Manages Accounts Receivable effectively, reviewing with manager problem claims.
• Reads and monitors bulletins from plans subscribed to for changes and updates in claims submission.
• Prepares daily deposit in a timely manner.
• Answers phones when necessary. 
• Print statements and collection letters.
• Follow up phone calls on collections.
• Greets patients in a professional, friendly and respectful manner on phone or in person.
• Obtain payer information with copies of current payer information on all new patients.
• Verify all information in the computer system is accurate for visits and make any necessary information changes.
• Enter patient information into computer system.
• Print admission sheets.
• Call insurance to verify patients co-payment and deductible amounts.
• Collect patient co-payment and deductible amounts according to payment collection policy.
• Records payments received in receipt book.
• Maintains cash drawer, ensuring on a daily basis that the cash drawer is in balance.
• Keeps track of patients who require payment in full at the time of service.
• Gives professional customer service to patients and public at all times.
• Obtains referrals when needed from patients that have a Primary Care Physician (PCP).
• Makes patients appointments as necessary.
• Maintains any logs necessary for collections and QA purposes.
• Download Medicare receipts on accounts.
• Post patient payments.
• Submits all claims to Medicare, Medicaid, primary insurances, and supplemental/secondary insurances.
• Enter charges for services rendered.
• Re-submits claims as necessary and handles appeals process when necessary.
• Researches and resolves correspondence from insurance carriers or private patients concerning claims.
• Reviews and corrects claim edits and denials to ensure proper payment for services rendered.
• Develops and maintains positive, effective working relationships with other employees, supervisors and medical providers.
• Fields and answers questions from patients regarding account/s. Replies to any inquiries in a timely manner.
• Ensure strict confidentiality of financial and medical records under HIPAA, HIPAA Security laws and hospital/clinic policies and procedures.
• Communicates clearly written and oral medical information to professional practitioners and/or the general public.
• Attends meetings as required.
• Miscellaneous duties as assigned requested or required.

QUALIFICATIONS:

• Communicates in an effective manner, follow written or verbal instructions and demonstrates good interpersonal skills to deal with team members, patients and families.
• Knowledge of insurance policies.
• Competent with the accounts receivable accounting system.
• Knowledgeable in accounting procedures.
• Competent in Microsoft Office Word and Excel.
• Maintain discretion and confidentiality in communications.
• Familiar with policies and procedures regarding reporting and release of protected health information (PHI).

EDUCATION and/or EXPERIENCE:

• High School Diploma/GED
• 1 year experience in bookkeeping, clerical and applicable computer training
• Prior physician office or medical coding, preferred
• Customer Service trained or experience, preferred

LANGUAGE/READING SKILLS:

• Communicate verbally and in writing in English.
• Additional language of Spanish preferred.

MATHEMATICAL SKILLS:

• Must be proficient at mathematical and statistical calculations.

REASONING ABILITY: Employee responds to unusual or varied situations that are not covered by existing standards, procedures and precedents. 

WORK ENVIRONMENT: Employee is regularly required to stand, walk, sit, ascend and descend stairs, possess ability to handle, finger or feel objects, tools or controls; reach with hands and arms. 

Employee must frequently be able to lift 25 pounds from the floor to waist level. Specific vision abilities include close vision and the ability to clearly focus vision.