Accounts Receivable Specialist

Accounts Receivable Specialist

The Accounts Receivable (AR) Specialist is responsible for supporting the Revenue Cycle Team with insurance accounts receivable. Responsible for reviewing all assigned accounts within a timely manner, maintaining metrics that fall within the expectations set by organizational leadership and based on national benchmarks. Must maintain a comprehensive understanding of the health insurance market, specific plan requirements, and standard payment options. Required to communicate with assigned region(s), team members, and third parties such as insurance companies, in a way that is perceived as thorough and clear. Responsible for researching missing insurance payments and collecting appropriate documentation to recording transactions in the practice management system.

Key Responsibilities:

• Communication: Must have professional and timely communications to practices and other Revenue Cycle teams.
• AR Follow-Up: Work assigned aging reports to ensure timely payments, fee schedule disputes, and cash posting is accurate. Identify claim denials and payment trends on claims.
• Secondary Claims Processing: Initiate the accurate and timely processing of all secondary claims, as needed.
• Audit patient ledgers for correct charge posting payments, contracted amounts, and adjustments.
• Denied Claims: Work denied and rejected claims and resubmit claims for reimbursement to the insurance companies for appropriate reimbursement; contest charges that are not paid or underpaid with the insurance carrier. If claim is denied, ensure correct denial code is used.
• Appeals: Complete all claim appeals according to payer specific, timely-filing guidelines; reviews clinical documentation for appeals and composes detailed formal appeal letters for payment or contacts provider for appeals letter.
• Adjustments/Write-Offs: Ensure policies are being followed according to company guidelines; audit accounts prior to making any adjustments or write-off; ensure correct adjustment or write-off codes are used.
• Performs other duties as assigned from time to time.

Qualifications:

• 2+ years' experience in Revenue Cycle working accounts receivable
• Experience reading explanation of benefits and communicating with Insurance plan representatives.
• Strong knowledge of Microsoft Office Suite products; specifically, Excel, Word, and Outlook.
• High School Diploma
• Knowledge of medical insurance and terminology
• Strong analytical, critical thinking and problem-solving skills
• Strong interpersonal and communications skills to be able to work successfully in a team-oriented environment.