AR Specialist (Full-Time)

About Diana Health

Diana Health is a network of modern women's health practices working in partnership with hospitals to reimagine the maternity and women's healthcare experience. We are restructuring the traditional approach to care to create an experience that is good for patients and good for providers. We do that by combining a tech-enabled, wellness-focused care program that women love with a clinical system that helps us drive continuous quality improvement and ensure work-life balance for our care team. We work with clients across all life stages to empower and support them to live happier, healthier, more fulfilling lives.

With strong collaborative care teams; passionate administrators and a significant investment in operational support, Diana Health employees are well-supported to bring their very best to the work they love. Come join us!

Role Description

The AR Specialist is a multi-tasking highly skilled position that encompasses all key functions of physician billing. The AR Specialist position requires an advanced revenue cycle knowledge that has been acquired through experience and developed through training and education. The AR Specialist supports patient-centered care and Customer Service by serving as a patient advocate during the life cycle of the account. Under direct supervision, the AR Specialist is expected to maintain productivity, accountability, and produce very efficient and proficient results.

Distinguishing Characteristics

The AR Specialist is a highly motivated individual with a proven ability to manage multiple tasks. The AR

Specialist will possess extensive knowledge of medical billing processes focusing on OB/GYN billing and insurance denials and be proficient in medical terminology, coding, and billing systems. The AR Specialist will manage telephone calls from patients, insurance companies, and medical practices to answer inquiries, follow up on outstanding claims, and update accounts as required. The AR Specialist will possess exceptional organizational skills, a mature, pleasant, and professional telephone manner, and the ability to prioritize work. The AR Specialist ensures that the aging Accounts Receivable (AR) is kept current and that all denials are researched and updated. The AR Specialist will respond effectively to sensitive inquiries or patient complaints to Diana Health's patient population.

What You'll Do:

Job Duties and Responsibilities:

• Utilize expertise in OB/GYN billing processes to investigate and resolve insurance denials through effective communication with payers and attention to detail in claim resubmissions.
• Navigate various payer portals to monitor claim status and eligibility and resolve issues promptly.
• Collaborate with internal teams to gather and provide necessary appeals and claims processing documentation.
• Maintain up-to-date knowledge of medical billing regulations and compliance requirements.
• Utilize medical collection practices and procedures to manage outstanding accounts receivable.
• Ensure accuracy in data entry and record-keeping for billing-related activities.
• Prioritize tasks effectively to meet deadlines and achieve goals.

Core Revenue Cycle Functions:

• Complies with Revenue Cycle policies and procedures.
• Works assigned task lists, work queues, work files and reports.
• Maintains current knowledge of third-party payor reimbursements and managed care contracts.
• Maintains knowledge and is familiar with physician billing, accounts receivable, and EHR systems.
• Utilizes and identifies all components of Explanation of Benefits (EOB)/Explanation of Payments (EOP).
• Accurately counts and tracks all daily activities and production.
• Completes and accurately documents activity or communication on accounts.
• Meets department production standards consistently as defined by department management.
• Works special projects as assigned by Manager, Supervisor, or others.
• This list is not meant to be restrictive, totally inclusive, or limited in employee assignment or responsibilities.

This list is not meant to be restrictive, totally inclusive, or limited in employee assignment or responsibilities.

Knowledge, Skills, Abilities:

• Language/Communication Skills
• Skill and ability to communicate effectively both verbally and in-writing.
• Ability to read and comprehend simple instructions, short correspondences, and memos. Ability to write simple correspondence.
• Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
• Mathematical Skills
• Adds, subtracts, multiplies, and divides in all units of measure, using whole numbers, common fractions, and decimals.
• Ability to understand and calculate figures and amounts such as simple discounts, interests, and percentage measures and to read tabular and bar graphs.
• Computer / Technical Skills
• Skill and ability in Physician Billing Systems (PB), Electronic Medical Records (EMR), and Microsoft
• Office applications with working usage of MS Word, Outlook, and Excel.
• Extensive knowledge on use of email, search engines, Internet, and ability to effectively use payor websites and portals.
• Requires proficiency with various healthcare computer system applications that are used by physicians in the office and in hospital settings to support patient care, billing, and financial information.
• Customer Service Skills
• Ability to advocate on patient's behalf, listen to patient concerns attentively, and address patient matters promptly, courteously, and respectfully.

Experience/Qualifications

• Minimum education required
• High School Diploma or General Education Degree (GED) required.
• Minimum experience required
• The AR Specialist will have 3 to 5 years of experience in medical claims collection and be familiar with aging reports, delinquent claims reports, correspondence, EOBs, and other sources of information.
• Knowledge of third-party insurance regarding plan types: HMO, PPO, POS, and Indemnity.
• Knowledge of the Medicare and Medicaid Programs (CMS) particularly concerning CPT codes and ICD-10 diagnostic coding. Thorough knowledge of Medicare Fraud and Abuse regulations.
• Functional knowledge and understanding of the mechanisms of Electronic Medical Records (EMR) and Physician Billing Systems (PB).
• Possess full knowledge of HIPAA regulations related to medical billing and coding.

Benefits

• Competitive compensation
• Medical, dental & vision plans, with an HSA/FSA option
• 401(k) with company match
• Paid time off
• Paid parental leave

Diana Health Culture

• Having a growth mindset and striving for continuous learning and improvement
• Positive, can do / how can I help attitude
• Empathy for our team and our clients
• Taking ownership and driving to results
• Being scrappy and resourceful