RCM AR Specialist, team Lead

Follows up on rejected claims and overdue insurance balances using Explanation of Benefits forms and reports. Builds and maintains relationships with specified payers and Practice Managers. Functions as the team lead to insure that regional assigned hubs are being handled properly by the team members.

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

Daily Duties

• Processes all paper and electronic claims for assigned carriers verifies completeness of paper insurance claim information before mailing
• Follows up on rejected claims the day that the rejected EOB is received
• Calls carriers to appeal payments that do not match contractual agreement; notifies Manager of payers for which this is a consistent problems
• Asks physicians to provide appeal language for denials or unacceptable payment
• Processes requests for refunds, and submits to Manager for approval
• Responds to written and telephone inquiries from patients regarding their insurance questions

Account Follow-Up

• Using data from the monthly aged accounts receivable report, calls payers or looks up claims status online to inquire about unpaid insurance claims that are 45 days old; records response or activity in the computer system notes
• Maintains detailed knowledge of practice management and other computer software as it relates to job functions
• Makes necessary arrangements for medical records requests, completion of additional paperwork, etc., if payers request this information prior to payment of claims
• Responds to written and telephone inquiries from insurance companies
• Manages relationships with personnel from assigned carriers
• Meets with Manager regularly to discuss and solve reimbursement and insurance follow up problems

Team Lead Function

• Coordinates special projects for assigned team. Ensures projects are completed within deadline constraints.
• Provides front line support for team by answering and filtering Accounts Receivable Rep questions. Forwards to appropriate contact when unable to answer question or resolve issue.
• Reviews teams monthly reports to track issues and identify potential training issues.
• Ensures all team members have an understanding of the most current information regarding carrier specific rules. Coordinates scheduling of insurance webinar sessions for team.
• Ensures all team members have a clear understanding of CBO policies and procedures.
• Works with Accounts Receivable Manager and trainer to ensure team members receive additional training as needed.

Other

• Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by the practice.

• Maintains detailed knowledge of practice management and other computer software as it relates to job functions.
• Attends OSHA, HIPAA, and OIG training programs as required.
• Attends all meetings as requested including regular staff meetings.

• Attends Medicare and other continuing education courses as requested. Pursue and participate in education to remain current with changes in the Healthcare industry.

• Performs any additional duties as requested by the CFO and/or Director of Central Billing Services.
• Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes.
• Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP EthicsPoint hotline.

Typical Working Conditions

Normal office environment. Occasional evening or weekend work.

Typical Physical Demands

Physical demands are moderate with occasional lifting of items weighing approximately 20-30 pounds. Position requires prolonged sitting, some bending, stooping, and stretching. Good eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment is also required. Employee must have normal range of hearing and vision must be correctable to normal range to record, prepare, and communicate appropriate reports.

EDUCATIONAL REQUIREMENTS:

• High school diploma required
• College education or trade school preferred

QUALIFICATIONS AND EXPERIENCE:

• Minimum eighteen months experience in a medical office reimbursement department
• Comfortable using email and interacting with Internet applications
• Knowledge of practice management and word processing software
• Proven understanding of Explanation of Benefits forms, claim forms and the insurance billing process
• Working knowledge of managed care, commercial insurance, Medicare, and Medicaid reimbursement
• Basic knowledge of CPT and ICD-10 coding
• Strong written and verbal communication skills