Insurance AR Specialist ASC

Department: CBO ASC                        Reports To: Manager, Revenue Cycle ASC

FLSA: Non-Exempt

Job Purpose:

The Insurance A/R Specialist performs insurance follow up, online claim submissions, records uploading and appeals for all facility claims.  

Primary Duties and Responsibilities:

• Manages claims utilizing workflow queues to prioritize and complete follow up in accordance with compliance, regulatory and billing guidelines and/or workflow, and specific payer protocols  

• Monitors claim status with payers via web or phone  

• Utilizes Artera as another way to reach and communicate with patients

• Utilizes software to identify underpaid and overpaid claims and files appeal letters to insurances regarding underpayment or initiate refunds/recoups for overpayments 

• Processes appeal denials obtaining referrals and retro authorizations as needed 

Competencies:

• Service:  We align our actions and decision making with the organization’s guiding platform keeping our patients at the center of all we do.

• Change Agent:  We support and contribute to positive change in the organization.

• Communication and Interpersonal Relations:  We communicate honestly and with compassion to build connections with our patients and each other.

• Effectiveness:  We take ownership of work, doing the right thing for our customer and doing it well.

Organizational Culture:

All OrthoIllinois employees focus on service by putting the mission, vision, and value statements into practice and using the guiding principles of Compassion, Respect, Trust, Integrity, Innovation, Education Fiscal Responsibility, Practice Independence, Accountability, and Empowerment to direct their interactions and decision making.  Employees promote and model the service standards to create lasting impressions, extraordinary moments, exceptional on-stage experiences, and meaningful and compassionate connections.    

Education and Experience Requirements:

• High School Diploma or GED

• A minimum of one year of experience in a similar position and/or performing similar tasks

• Prior medical claim Accounts Receivable experience preferred

• Working knowledge of Microsoft and Google Suites

• Knowledge of the Experian and Payer websites preferred

Environmental/Working Conditions: 

Working environment is in an office/clinic setting.

Physical/Mental Demands:  

• Sit or stand for extended periods of time.

• Lifting, carrying and/or moving objects in a manner consistent with most office environments (generally, no more than 10 pounds on a frequent basis and 20 pounds on an occasional basis).

• Finger dexterity for typing on a keyboard and using a mouse for extended periods of time; ability to twist hands or wrists repetitively. 

• Vision (e.g., depth perception, color vision, strong vision up close) and hearing (e.g., high pitch sounds, soft or distant sounds). 

This description is intended to provide only basic guidelines for meeting job requirements.  Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve