What are the responsibilities and job description for the AR Specialist position at Complete Health?
SUMMARY OF JOB DUTIES:
The person handling this position is responsible for correcting, completing, and processing and collecting payment for claims of all payer codes.
ESSENTIAL JOB FUNCTIONS:
- Resolving claim denials and issues with claim payment in a timely manner.
- Follow-up with insurance companies regarding unpaid claims and denials.
- Review claim data for completeness and accuracy. This includes updating account information, reviewing claim history and EOBs, validating diagnosis, CPT and ICD codes, and transferring charges to the correct carrier or agency.
- Correct and refile claims
- Make adjustments to claims and patient accounts based on adjustment policies.
- Effectively communicate with providers on claim documentation for charges submitted.
- Ensuring payer portal accounts are accessible for claim research.
- Work with office staff and revenue cycle manager to investigate and help resolve coding and billing issues.
- Collect patient and insurance balances in a timely manner.
- Answer billing phone calls and providing exceptional customer service to patients with billing related questions when needed.
- Submit initial electronic claims when necessary
- Cross train in other aspects of the department as assigned
- Other special projects or duties as assigned.
MINIMUM REQUIREMENTS
- High School Diploma or Equivalent
- CPC Certification preferred
- At least 1 year of billing and AR follow up experience (outpatient/medical practice coding experience preferred)
- Training or background in ICD-10 / CPT codes.
- Knowledge of medical terminology and billing practices.
Knowledge/Skills/Abilities:
- Ability to work under pressure and multi-task.
- Ability to problem solve and pay attention to detail.
- Understanding of community-based organizations.
- Ability to communicate with the medical staff and management.
- Ability to work proficiently and efficiently on a timely manner.
- Knowledge of all payer codes.
- Understanding of the life cycle of a medical billing claim and how to improve the revenue cycle
- Expertise in effective claim follow-up, patient follow-up, and denial resolution
WORKING ENVIRONMENT
The position requires climbing, stooping, kneeling, crouching, reaching, standing, lifting, grasping, feeling, talking, hearing, repetitive motions, and finger use. Pushing and pulling are occasionally required. Use of a computer, keyboard, and telephone along with various office machines is an essential part of the job.
DISCLAIMER
The above statements are intended to describe the general nature and level of work being performed by the Accounts Receivable Specialist. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. The Accounts Receivable Specialist may be required to perform duties outside of their normal responsibilities from time to time as needed or as directed by supervision.