Description

Job Summary

Across multiple billing systems, the Accounts Receivable Specialist (ARS) diligently organizes, bills, recovers and resolves FHN’s open accounts receivables positioning FHN for solid cash performance. The ARS will utilize multiple tools and systems to analyze and execute the daily throughput (including the processing of approved account corrections) of revenue cycle billing and payer follow up, which includes quality assurance and issuance of insurance claims, client statements, and guarantor billing statements. This position has a direct correlation to the daily level of cash flow at FHN. The in-depth field knowledge allows this level of talent to review and initiate the highest-level claims appeals. Their level of knowledge and expertise in managed care contracts and government billing rules/regulations is a specialty skill that is acquired through on the job training, accounts receivable management experience, and keeping abreast of ongoing payer specific changes through provider manuals, payer websites and managed care contracts.

Job Responsibilities

• Process account and claim corrections to ensure accurate and compliant billing upon partnering with HIM and hospital/practice leadership for direction.
• Performs in-depth analysis of daily client and claim files prior to electronic submission to payers for adjudication and payment remittance. Understands 1500/UB claim formats to make accurate corrections to claim errors in a timely manner and leverages electronic claim submission in all circumstances through the clearinghouse for prompt processing and reimbursement.
• Analyzes open AR and formulate follow up tactics to resolve “like account situations” (segmentation) to secure cash flow. Leverages business intelligence and the high-impact work lists that are built around each payer’s payment window allowing electronic organization of open A/R to initiate resolution on accounts prior to becoming delinquent. Prioritizes work list through business intelligence platform to plan daily approach in turning over denied, pended, adjudicated, submitted and promise to pay accounts receivable into cash across multiple payers. Overturns large complex denials through written and verbal appeals with all necessary documentation to turn unpaid claims into cash. Incorporates payment discrepancy review on managed care and government payers and addresses underpayments promptly to ensure contractual payer reimbursement is accurate. Complies with standard operating procedures to review and process any overpayments made by a payer. Appeals payer refund requests when request is inaccurate.
• Assists in training of others and provides assistance to other teams.
• Communicates effectively and efficiently with payers over the phone or provider portals. Resource to Customer Service team members assisting patients with questions ranging from insurance explanation of benefits questions to self-pay, financial assistance or billing statements. Diffuses concerns and provides on the spot resolution. Counsel’s patients on residual self-pay balances – collecting balances in full, arranging an acceptable payment plan, identifying other funding sources, or applying the patient for financial assistance. Delivers timely through-put and resolution to customer questions and concerns.
• Provides payer specific AR status updates to leader including trends and issues with possible resolutions weekly that have direct impact to KPI targets. Utilizes analytics and quality reporting to capture inaccuracies within the systems and reports to leadership and staff daily.
• Keeps abreast requirements for CPT, HCPCS, and ICD-10 billing and other payer changes. Identifies, recommends, documents and rolls out process improvement opportunities to peers.

Qualifications

Requirements

Education: Associates Degree or equivalent years of related experience required

Required Experience: 2 – 5 years

Special Skills and Abilities:

• Medical Terminology
• Managed Care Structures and/or Contracting
• Coding Certificate
• Insurance Certificate
• Specialized Customer Service Training

Licensure/Certification/Registration: HFMA CRCR (Certified Revenue Cycle Representative) required within 1^st year of hire

Populations Served

While performing this job, the employee may care for patients in the following age groups.

• No direct responsibility to treat or care for patients

While performing this job, the employee does not care for patients in the following age groups.

• Neonate (< 30 days)
• Infant (< 1  year old)
• Early Childhood (1 year and < 5 years old)

• Late Childhood (5 years and < 13 years old)
• Adolescent (13 and < 17 years old)
• Young Adult (17 to < 30 years old)
• Middle Adult (30 years to < 60 years old)
• Older Adult (> 60 years old)
• Serves patients in areas other than direct patient care

Salary : $15 - $25