Position Summary:

Under the direction of the AR Manager and Supervisor of Reimbursement & Patient Account Services, the AR Specialist is responsible for resolution of patient account balances associated with insurance denials, answer incoming insurance and practice calls with the ability to explain charges, services and insurance billing questions. Work with practices and payers to resolve claim denials and comply with insurance and SMG procedures, guidelines and policies

Key Responsibilities:

• Various aspects of medical billing; claim creation, claim submission, payment posting for insurance and patient balances. These denials and appeals are billed in the AthenaNet system electronically. The AR Specialist must also obtain supporting documentation, i.e., medical records, EOB’s Remits, Authorizations, referrals, etc., from through our email applications, scanning system, Medicare remittance system, and Meditech (hospital billing system). The AR Specialist will review, interpret and apply contractual terms. Identify and/or apply contractual and administrative adjustments.
• Monitor insurance denials by running reports and contacting insurance companies to resolve and recover denied claims.
• Monitor aging reports for timely follow-up on unpaid claims.
• Knowledge of payer authorization guidelines in an effort to determine if appeal requires a clinical review or can be handled from a technical perspective.
• Knowledge of Third party payer and government guidelines.
• Retroactive review of registration data to aid in the assurance of clean claim submittal.
• Accurately document claim actions taken within patient account / claims.
• Ability to navigate and toggle back and forth within multiple payer websites and internal billing systems to determine various aspects of account detail necessary for data management.
• Assist in orientation and training of new staff, including work flow and system training.
• Serve as a resource for problem solving issues related to registration, demographic and insurance errors.
• Work payer correspondence including support tickets, emails and phone messages from internal and external contacts.
• Work collaboratively with Coding, Provider Enrollment and Cash Posting team as well as coworkers, Team Leads, Managers and practice staff to resolve claim and account issues.
• Assist Patient Accounts Team as needed with incoming and outgoing patient calls to resolve and collect on a patient statement.
• Adhere to the HIPAA guidelines regarding confidentiality relating to the release of financial and medical information.
• Additional duties as assigned by Manager

Required Knowledge and Skills:

• Customer / Patient Account Services Skills
• Successfully drives results while balancing multiple priorities and tasks
• Ability to keyboard at 35 words per minute
• Ability to diagnose and troubleshoot problems Ability to perform mathematical calculations
• Must have knowledge of ICD-9 and CPT-4 coding
• Strong knowledge on third party payors guidelines and procedures particularly
• Attention to detail.
• Possess strong verbal and written communication skills
• Possess strong analytical skills and computer skills; including Outlook, Excel and Word.

Education:

• Associates Degree in Business, Accounting or Finance preferred

Experience:

• 1-3 years experience and/or knowledge of insurance denials process
• 1-3 years health care claims processing, and follow-up background
• 1-3 years billing experience and insurance knowledge (eligibility, registration, etc.)

Certification/Licensure:

• Certified Biller preferred