Out of Network Accounts Receivable Specialist – Remote

Description

**This position offers the flexibility for a hybrid/remote arrangement, contingent upon the candidate's proximity to our headquarters in New Jersey.**

Out of Network Accounts Receivable Specialist

As an Accounts Receivable Specialist in the Patient Letters Division, you will play a crucial role in ensuring the financial health of our organization by managing and optimizing the accounts receivable process. You will work closely with healthcare providers, insurance companies, patients, and internal departments to maximize revenue and minimize outstanding balances. This position requires attention to detail, strong analytical skills, and a deep understanding of medical billing and reimbursement processes.

Responsibilities:

• -Remittance Strategy: Meticulously analyze Electronic Remittance Advices (ERAs) and EOBs to identify claims where Horizon BCBSNJ has issued payment directly to the patient.

• -Check Recovery & Reissuance: Act as the primary liaison between the practice, the patient, and the carrier. When payments are sent to the member, initiate proactive outreach to secure those funds or coordinate with Horizon to void and reissue checks directly to the provider whenever possible.

• -Patient Coordination: Conduct high-level follow-up that goes beyond standard "collections." This involves educating patients on the Horizon OON payment process and guiding them through the endorsement and turnover of insurance checks.

Basic Requirements:

• -Claim Resolution & Revenue Recovery: Driven by a commitment to capturing OON revenue, specifically specializing in the "chase" required when payers diverts payments to patients. You not only resolve claims, but will also ensure patient's turn in the owed funds.

• -Strategic Organizational Skills: Highly organized with a forensic-level attention to detail when analyzing remittances. You must be able to track complex "member-paid" cycles, including check numbers, mailing dates, and reissuance statuses, ensuring no outstanding balance falls through the cracks.

• -Self-Directed Analysis & Collaborative Action: Capable of performing deep-dive independent remittance reviews while seamlessly collaborating with the team to trigger patient outreach or insurance escalations the moment a diverted payment is identified.

• -High-Impact Communication: Exceptional verbal and written skills used to navigate two distinct worlds: advocating firmly with insurance carriers for check reissuances and communicating empathetically yet effectively with patients to secure checks mailed to their homes.

Experience Requirements:

• -Medical Billing/Collections Professional: Proven experience in resolving denied/underpaid claims and conducting thorough follow-ups with insurance providers to maximize reimbursements.

• -Diverse Responsibilities: Extensive experience in various aspects of medical billing and collections, including but not limited to claim submissions, attorney follow-ups, and other duties relevant to the field.

• -Specialized Expertise: Prior experience in Conservative Therapy (Physical Therapy, Occupational Therapy, and Chiropractic), Medical (Physical Medicine and Rehabilitation, with expertise in Pain Management, Orthopedic, and Vascular disciplines), or Patient Accounts (Self Pay) is preferred.

• -Excel/Google Sheets: Demonstrated proficiency in utilizing Excel and Google Sheets for data analysis and reporting purposes.

• -Out of Network Experience: Proven track record of handling Out of Network billing processes effectively.

• -Payer Portals: Familiarity with various Payer Portals for streamlined communication and efficient claims processing.

• -Insurance Knowledge: Extensive experience with all Major Medical Insurance Providers, Work Comp, and Motor Vehicle claims is preferred.

• -Bilingual Skills: Fluency in Spanish is a plus.

Background Check Requirement: Employment is contingent upon the successful completion of a background check, which may include verification of employment history, education, criminal records, and other relevant information as permitted by law