Senior Accounts Receivable Specialist

Job Summary

The Senior Accounts Receivable Specialist position is responsible for complex AR management and escalations. Dedicated to ensuring accurate, compliant, and timely billing including reimbursement services from payers and patients.

Key Responsibilities

AR Follow-Up and Escalations:

• Perform diligent research and follow-up on the status of complex claims and proactively resolve any outstanding issues to expedite payment.
• Review, assess, and process claim appeals including resubmitting to insurance carriers with accurate support documentation to maximize reimbursement.
• Main point of contact for offshore escalations, assigned tasks, and clarification training calls.

Documentation:

• Identify and report any billing problems, errors, or discrepancies to management, facilitating proactive resolution of billing trends and ensuring ongoing revenue integrity.
• Maintains accurate and updated billing procedures.

Reporting:

• Monitor and validate reporting for AR balances and trends.
• Review weekly aged receivables for accounts requiring additional follow-up.
• Determine trends in denied payments and remediation solutions.

Audits:

• Perform billing audits to ensure compliance with Medicaid and other insurance guidelines.
• Audit patient accounts in practice management system and update as necessary including processing refunds.
• Audit offshore production for training opportunities.

Payer Reimbursement Rates:

• Monitors reimbursement rates from insurance companies.
• Validate reimbursement rates are paid according to fee schedules.
• Request updated fee schedules as needed and append to databases.
• Identifies, implements, and tracks appeal projects as needed for underpaid claims.

Education and Credentials

• High school diploma or equivalent.
• Prefer coursework and/or experience in medical and/or health insurance billing, medical records management.

Experience

• At least two years of previous medical insurance, billing, or claims processing related experience.
• 2+ years of offshore labor mixed team.
• History of SOP creation and execution.
• Comprehensive understanding of accounts receivable in a healthcare setting.
• Strong understanding and experience in billing processes and appeals.
• Working knowledge of managed care plans, insurance carriers, referrals and pre-certification procedures.
• Strong knowledge of ICD-10, CPT, HCPCS, modifiers and coding documentation guidelines. CPT and ICD-10 certification a plus.

Skills and Competencies

• Strong keyboarding and computer skills to include MS Office (Word and Excel) experience at an intermediate level. 10-key data entry proficiency.
• Knowledge of medical coding and third-party operating procedures and practices as well as knowledge of financial concepts.
• Experience working with basic office machinery and equipment, including computers, copiers, fax machines, multi-line phone systems, etc.
• Knowledge of HIPPA privacy and security rules and regulations.
• Excellent interpersonal skills, with the ability to communicate effectively with others.
• Strong organizational skills, with the ability to multi-task and meet deadlines.
• Demonstrates initiative, with the ability to manage self and workload.
• Strong analytical and problem-solving abilities. Good mathematical aptitude.
• Exemplary customer service focus, for both internal and external clients.
• Able to work both independently and be self-directed, as well as being able to perform in a team atmosphere.
• Displays professionalism and represents organization in a professional manner.
• Ability to abide by ethical guidelines and policies, including strict adherence to confidentiality and HIPPA guidelines.