The Specialist Accounts Receivable is responsible for accurate and timely Insurance claims error resolution, submission, insurance follow-up, and accounts receivable resolution for assigned payers, aging, and/or patients. The Specialist is accountable for resolving open claims, appealing denials, aged claims resolution, and special accounts receivable projects. The Specialist adheres to government regulations, payer contracts, and insurance guidelines when performing edit resolution, insurance follow-up, denial management, and appealing claims.
The Specialist is a key front-line contributor to the Revenue Cycle identifying and reporting inefficiencies and opportunities that enhance revenue flow, decrease denials, and minimize write-offs.
Essential Job Functions:

• Analyzes lab orders, claims, explanation of benefits, correspondence, payer website, and/or any additional information necessary to identify the next appropriate action toward payment resolution.
• Follows government, commercial, and/or third-party payer guidelines to ensure complete and timely follow-up on open balances for assigned payers or accounts.
• Performs appeals, underpayment appeals, claims, and payment disputes by following government, commercial, and third-party payer appeals guidelines or contracted terms.
• Utilizes payer contracts, fee schedules, and appeal letters to perform underpayment, medical necessity, and general appeals.
• Develops appeal letters and appeal procedures based on payer requirements. Ensures offshore the team is trained and utilizing appeals tools.
• Assists Supervisor with quality reviews for the offshore accounts receivable team. Provides 1:1 coaching to increase technical expertise.
• Supports Cash Applications by researching and resolving unapplied payment or deposit inquiries as needed to post timely and resolve open balances.
• Evaluates payer denials to identify the root cause and assist in documenting resolution procedures.
• Works to minimize write-offs by exhausting all resolution options and performing thorough research/review of all appropriate resources.
• Adjusts account or requests write-offs adhering to Lifescan Labs policies and procedures.
• Notifies Supervisor when insurance plans deny services, which are covered based on the contract terms, government regulations, third-party agreement, or patient’s benefit plan.
• Works to minimize write-offs by exhausting all resolution options and performing thorough research/review of all appropriate resources. Adjusts account or requests write-offs adhering to Lifescan policies and procedures.
• Reviews denial analysis reports and makes recommendations to the Revenue Integrity and Claims Processing Teams for submission changes based on claim denials.
• Researches payer and government websites and/or medical resources, to identify payer claim requirements necessary to resolve open accounts receivable.
• Collaborates with Client Services and Clients to resolve coding-related denials and resubmit coding-related corrected claims and/or appeals.
• Targets and reports any internal procedures or processes that may negatively impact or increase days in accounts receivable or delay claims resolution.
• Interacts with patients, government payers, and third-party payers to respond to billing requests as appropriate.
• Assists Client Services with client requests by reviewing accounts and providing claim information and/or claim status.
• Continually meets or exceeds productivity and quality metrics for Account Receivables Specialists.
• Participates in standard operating procedure and training documentation creation and maintenance as needed.
• Remains current with trends, regulatory requirements, and business strategies related to the payer relations and revenue cycle.
• Operates in compliance with all local, state, and Federal laws as well as policy and compliance standards.
• All other duties as assigned.

Requirements

. XIFIN laboratory revenue cycle system experience preferred.

N/A.