Insurance Accounts Receivable and Payment Representative

Overall Responsibility: Position requires accurate and timely follow up on outstanding claims. This individual needs to be knowledgeable in CPT guidelines, modifiers and ICD 10 coding.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Completes payment entry in a timely and accurate manner including:

o Posts payments to practice management system (live checks within 24 hours, EFT deposits within 72 hours)

• Records batch totals with date and initials on payment receipt spreadsheet
• Balances batches and runs transaction reports
• Verifies all EFT deposits and scanned checks have been posted by month end
• Properly communicates and documents payment denials in the practice management system and to the appropriate billing representative in a timely manner.
• Identifies any payments not being paid at the allowed/contracted amount and communicates this to the appropriate billing representative – AR and/or Director.
• Review of Explanation of Benefits for correct reimbursement.
• Review insurance claims denials. Respond to insurance denials/corrections by appeal process or telephone calls.
• Follow up on appeals with 30 days.
• Make account comments to clarify actions taken to reconcile outstanding posting issues in the billing notes.
• Review and send medical records for audit request.
• Answer patient billing questions and identify and resolve patient billing issues.
• Request retro authorizations for services when needed.
• Review Aging Analysis Report on a monthly basis for past due insurance claims.
• Call insurance carrier or resubmit insurance claims of past due claims.
• Provide input to charge posters regarding posting issues.
• Update patient demographics to produce a clean claim for transmittal.
• Update key personnel on insurance changes.

Skills and Attributes

Ability to multi-task

Strong organizational skills

Self Starter

Education and/or Experience

High school diploma or general education degree (GED); and twelve to eighteen months related experience and/or training; or equivalent combination of education and experience