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Form of workOverview:
Medical A/R Specialist is responsible for all steps in resolving patient account balances with insurance payers. This process includes online with payer websites for inquiries and telephone follow up with the payers to ensure proper reimbursement is received for provider services billed. Reviewing medical records for appropriate documentation inclusive of correct CPT and payable ICD-10 codes before sending to payer, filing necessary appeals or other miscellaneous steps to ensure payment.
SpecialCharacteristics:
This position requires a comprehensive understanding of Accounts Receivable management in a healthcare setting. This position requires a strong working knowledge of managed care plans, insurance carriers, referrals and precertification procedures. Also required is a strong working knowledge of CPT, ICD-10, HCPCS, modifiers, coding and documentation guidelines. Strong customer service, organizational and communication skills are essential to this position. In addition, strict adherence to write-off policies, refund policies and other Accounts Receivable policies as outline in the department procedure manual is required. This position requires an ability to prioritize multiple tasks simultaneously in an occasionally stressful environment. Also required are midlevel computer skills, typing skills and a working knowledge of Medicare compliance and HIPAA guidelines.
Essential Functions:
1.Provide support services both on the telephone and in office as applicable for patients and authorized representatives regarding patient accounts. Calls regarding account inquiries should be returned no later than the next business day.
2.Follow up on all outstanding insurance claims at 60 days from the date of billing following established guidelines.
3.Provide information pertaining to billing, coding, managed care networks, insurance carriers and reimbursement to providers, client staff and co-workers.
4.Follow up on all returned claims, correspondence, denials, account reconciliations and rebills within five working days of receipt to achieve maximum reimbursement in a timely manner with emphasis on timely resolution.
5.Recommend accounts for adjustments following department guidelines.
6.Monitor reimbursement from managed care networks and insurance carriers to ensure reimbursement consistent with contact rates.
7.Answers inquiries from client staff regarding billing issues.
8.Participates in educational seminars.
9.Proficiency with all payer web sites and eligibility portals to check claim status, to efficiently conduct Accounts Receivable follow up and to maximize revenue.
10.Proficiency with facets of the PM (Practice Management) system including patient registration, charge entry, insurance processing, advanced collections, reports and ledger inquiry.
11.Maintain information regarding coding, insurance carriers, managed care networks and credentialing in an organized, easy to reference format.
12.Maintain an organized, efficient and professional work environment.
13.Adhere to all policies related to HIPAA and Medicare compliance.
14.Maintains strictest confidentiality.
15.Other duties as assigned.
The job holder must demonstrate current competencies applicable to the job position.
Education: High school graduation and prior experience working in a medical billing office. Require minimum of 3 years Accounts Receivable experience preferably in one of the medical specialties of our current clients.
Skills:
1.Skills in computer programs, spreadsheets and payer applications and websites.
2.Skill in using a calculator.
3.Skill in typing 40 wpm.
4.Requires strong basic mathematical skills.
5.The jobholder must demonstrate current competencies applicable to job position.
6.Requires excellent written and verbal communication skills and strong customer service skills.
7.Requires and extensive working knowledge of managed care networks and insurance carriers.
8.Requires and extensive knowledge of Accounts Receivable functions including CPT and ICD-10 coding.
9.Requires proficiency in working general office equipment.
10.Requires proficiency in working with a PC, the Internet and MS Windows.
11.Requires high degree of organization and problem-solving skills.
Abilities:
1.Ability to understand and interpret policies and regulations.
2.Ability to examine documents for accuracy and completeness.
3.Ability to prioritize and multitask.
4.Ability to communicate effectively and in a professional manner with others.
