Description

Summary: The Accounts Receivable Specialist is responsible for follow up and collection of outstanding patient and insurance balances to encourage stable AR metrics and revenue.

Essential Duties and Responsibilities

• Review aging reports to identify issues outstanding balances and take steps towards balance collection
• Identify and resolve claim denial/non-payment trends .
• Review patient balances for self-pay collections
• Initiate claim appeals where appropriate.
• Review and address rejected and invalid claims.
• Respond to patient requests regarding billing questions/concerns
• Review credit balances for accuracy prior to generating refund requests.
• Keeps abreast of changes in Medicare, Medicaid, and insurance providers regarding pre-certification procedures.
• Working knowledge of CPT codes, ICD10 codes and Medical Terminology.
• Upholds the CDHA mission by actively contributing to the achievement of organizational goals, supporting leadership, promoting unity and teamwork for the benefit of patients.
• Demonstrates a commitment to quality of care.
• Maintains a clear focus on patient safety in every interaction with every patient.
• Actively participate in workplace improvement to maintain a patient service excellence environment.
• Adheres to all industry standards related to infection control, patient confidentiality, and regulatory and accrediting body's requirements (i.e. HIPAA, OSHA, and AAAHC).
• Follow and comply with all safety policies.
• Additional duties as assigned within the scope of responsibility.

Requirements

To perform the job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education/and or Experience:

• High School Diploma or GED.
• Minimum two years in medical billing, as a claims processor, medical claims for an insurance carrier, or clerical/billing experience in a medical office preferred.
• At least one year of experience in medical aging account collection
• Knowledge of medical billing software.
• Must be able to successfully interpret Explanation of Benefits and Electronic Remittance Advice statements.
• Excellent organizational, problem-solving and critical thinking skills are required.
• Must be a team player and able to work with various departments throughout the organization.
• The ability to maintain confidentiality is required.
• Ability to communicate effectively both verbally and in writing.
• Participates in performance improvement activities.
• Is actively committed to meeting or exceeding employee expectations/satisfaction in the performance of job functions.
• Retains all accreditations, licensures, and designations in good standing.
• Maintains compliance with all laws and applicable regulatory requirements. Acts promptly to comply with required changes.