POSITION SUMMARY:

The Infusion A/R Specialist contacts payers for medical claims status, follow-up denials, or partial payments. 

ESSENTIAL FUNCTIONS:

• Contacts payers for medical claims status, follow-up denials, or partial payments
• Obtains payer requirements for timely adjudication of claims
• Files claims with appropriate documentation attached
• Pursues, maintains, and communicates medical coverage/guideline changes/updates
• Processes all incoming and outgoing correspondence as assigned
• Verifies, adjusts, and updates Accounts Receivable (A/R) according to correspondence received from insurance company
• Helps facilitate interoffice communication on error and denial trends
• Initiates the review/appeals process on disputed claims
• Research credit balances and initiates refunds as required
• Manages Bill Review and Ready to Bill Ques
• Helps facilitate interoffice communication on error and denial trends
• Documents all activity in customer's computer account
• Answers Accounts Receivable phone inquiries
• Works assigned reports
• Available to assist others with questions or collection needs
• Manages Recurring Rental Files 
• Works Waystar Rejections and edits
• Ensure claims have appropriate codes, modifiers and charged amounts
• Validates correct coding initiatives 
• Acts as liaison between staff and management
• All other duties as assigned
• Manages complete account and host meetings w/ front end to determine root cause, process improvements
• Runs and maintains weekly and monthly reporting 
• Manages self pay adjudication, payment plans, ensures cards on file are current and accurate
• Provides education to front end and KPHC employees 
• Keeps up to date with industry standards, payer policies and prevents denials
• Works on monitoring compliance with payer contracts 

OTHER RESPONSIBILITIES:

• Provide excellent customer service while taking inbound calls and assisting patients with requests and billing questions 
• Maintains professional appearance and conduct at all times.
• Uses PTO appropriately

EDUCATION, EXPERIENCE, AND SKILLS REQUIRED:

• High School Diploma or General Education Degree (GED) required
• Past performance shows solid evidence of insurance qualifications and guidelines
• Knowledge of telephone etiquette and adequate oral and written communication skills
• Shows effective multitasking skills
• Positive and cooperative attitude in working and communicating with individuals at all levels of the organization

• Knowledge of medical field preferred

SUPERVISORY RESPONSIBILITIES:

None assigned

PHYSICAL AND ENVIRONMENTAL REQUIREMENTS: 

Standard office setting with minimal noise levels.

Benefits

We offer competitive pay and generous paid time off along with:

• Health Insurance
• Dental
• Vision
• Life Insurance
• Long- and Short-term disability
• Retirement plan with match after 1 year of employment
• Free SAMS club membership