Full-time Remote/Work from Home

Work Hours M- F, 8 am - 5 pm

The Accounts Receivable Specialist ensures financial integrity and accounts receivable 
by performing established financial processes that expedite medical services' billing and 
collection. This includes creating claims according to regulations and compliance 
guidelines, patient account research and resolution, insurance verification and benefit 
determinations, identification of reimbursement issues, resolution of credits and 
issuance of refunds, identification of payment variance invoices, follow-up, and 
resolution of denied claims. Responsible for working correspondence denials and 
insurance follow-up. This must be done in a timely and accurate manner, in accordance 
with the provided work instructions by performing the following duties. 

Responsibilities include, but are not limited to, the following:

• Monitor and execute work against the assigned team associated Custom Claim 
  Worklist(s), relational AR Worklist(s), reporting, projects, or team/department goals.
• Oversight of HOLD Worklists.
• Research and resolution of claims based on assignment, the process of which 
  could include:
  o Contacting payers via phone or website, contacting practices, navigating 
  cross-departmentally, writing appeals, and facilitating their direction to 
  Athena CBO for submission, and all other activities that lead to the 
  successful adjudication of eligible claims.
• Coding and charge entry based assigned work and associated responsibilities 
  (Specialty, CPC).
• Responsible for assigned AR including all Holds, Mgr. Holds and outstanding AR 
  requiring follow-up.
• Run reports for analysis, trending, subdivision of work, or distribution based on 
  direction (both self and managerial) as needed to communicate with all internal 
  stakeholders.
• Manage and resolve Zero-Pay Worklist, Fully Worked Receivables, complete 
  special project work, review and respond to adjustments/payment data with 
  approval (or initiate appeal) communicate trends and root issues through proper 
  lines of reporting.
• Receive calls or emails from Patient Financial Services Specialists with patient’s 
  requesting advanced assistance with their account.
• Illustrate excellent knowledge of healthcare industry regarding the revenue cycle, 
  coding, claims, and state insurance laws.
• Create patient cases to the correct clinical contact for additional information or 
  corrections to be made with the appropriate details of what is needed.
• Meet productivity standards as set by management.
• Keep management informed of correspondence and communication problems with 
  service locations.
• Maintain knowledge and understanding of insurance billing procedures to 
  understand the reason for claims in HOLD, MGRHOLD, and OVERPAID status to 
  ensure resolution and timely payment.
• To ensure accurate processes, educate and communicate revenue cycle/financial information to patients, payers, co-workers, managers, and others as necessary to ensure accurate processes.