Accounts Receivable Specialist

Job Overview:

The Accounts Receivable Specialist is responsible for reviewing, analyzing, and acquiring payment on all unpaid patient insurance billing, and for the research and follow-up of accounts to ensure timely collection of outstanding A/R.

RESPONSIBILITIES:

• Review all outstanding insurance balances greater than 30 days old for assigned accounts following Phoenix Heart policy and procedure.

• Perform audits of patient accounts to ensure accuracy and timely payment.

• Review account aging; identify, report, and correct inconsistencies and errors.

• Research rejections, denials, bad debt, and other assigned projects.

• Review credit balance reports for correct recipient of funds; perform reconciliation of refund accounts, attach documentation, and forward to manager to process refund checks.

• Review and research EOBs.

• Contact insurance companies or patients by phone, internet, or mail regarding outstanding balances.

• Verify patient coverage, authorization, and billing inquiries.

• Update patient insurance and demographic information as supplied by patient, insurance carrier, or internet website and file all affected claims.

• File corrected claims when determined that the original submission was incorrect.

• Submit claim appeals as required by each insurance carrier when denied in error; request the assistance of a coder when necessary.

• Resubmission of claims and submittal of appeals.

• Follow-up, respond, modify, or appeal all zero payments within five (5) business days of receipt.

• Follow-up on the status of submitted appeals and corrected claims within four (4) weeks of submission.

• Note and document all insurance and patient communication in the patient account.

• Review visit owners as assigned on a daily basis.

• Assist patients within the clinic with billing questions and inquiries.

• Run credit card payments, credit patient accounts, and mail patient receipts.

• Respond to patient billing and statement inquiries if the Patient Coordinator is unavailable.

• Respond to insurance company requests for information in a prompt and professional manner.

• Inform the Billing Manager, Account Representatives, and Payment Poster when a consistent payment discrepancy is identified with an insurance carrier.

• Maintain and develop a professional and positive relationship with provider reps and customer service department personnel for assigned carriers.

• Must have excellent communication skills with both internal and external customers.

• Must have the ability to effectively deal with stressful situations in a calm and productive manner, while maintaining the highest degree of customer satisfaction.

• Always performs concise and thorough documentation in patient charts.

• Maintains strictest confidentiality and abides by all HIPAA requirements and standards.

• Ability to keep sensitive information confidential.

• Participation in new hire/annual training is a condition of employment.

• Other duties as assigned.

Other Requirements:

• Must be able to act calmly and effectively in a busy or stressful situation.

• Ability to communicate effectively in the English language in person, by phone and in writing.

• Requires adherence to all policies and procedures, including but not limited to standards for safety, attendance, punctuality and personal appearance.

• Must be able to establish and maintain effective working relationships with managers and peers.

• Ability to work outside core business hours as needed.

• Exposure to Blood Borne Pathogens (BBP) and Other Potentially Infectious Materials (OPIM) is rare but possible. Vaccinations and training are offered upon hire.

KNOWLEDGE, SKILLS and ABILITIES:

• Extensive knowledge and understanding of medical health insurance, claims denials, and A/R processes.

• Knowledge of Medicare and major commercial payer guidelines.

• Understanding of coding conventions, including: CPT, ICD-10 codes and modifiers.

• Medical terminology.

• Ability to interpret payer medical necessity guidelines.

• Excellent oral and written communication skills.

• Superior customer service skills; ability to interact effectively and work efficiently with people at all levels in an organization.

• Familiarity with Microsoft applications, including Word and Excel and Internet/Web skills.

• High level of proficiency with PC based software programs.

• Ability to prioritize and organize work to meet strict deadlines.

• Ability to solve problems, prioritize, and multi-task in a deadline driven environment.

• Ability to make independent decisions regarding matters of significance.

• Work with little to no supervision.

• Able to work in a team environment and interact positively with team members.

• Goal oriented, with excellent time management and organizational skills.

• Must be self-motivated and service oriented.

• Demonstrates strong analytical and problem-solving skills.

• Works carefully and precisely with a strong attention to detail.

• Maintains good attendance and reports to work on time.

EDUCATION:

High school diploma or equivalent required. One (1) year certificate from college or technical school preferred. Must have extensive knowledge and understanding of medical health insurance and the processes involved in claims payment.

ALTERNATIVE TO MINIMUM QUALIFICATIONS:

Two (2) or more years related experience and/or training; or equivalent combination of education and experience.