Credit Balance Specialist-Medical Claims

100% Remote!!

Our team assists healthcare providers with the remediation of 3rd party accounts receivable, call center support and a variety of revenue cycle outsource capabilities. Under the direct supervision of the Revenue Cycle Manager, the PAR II applies professional administrative knowledge and skill while providing accountable oversight of their assigned work queue; processes procedures and projects in order to deliver superior 3rd party A/R account remediation, productivity, and quality outputs for the assigned client. The primary role is to resolve aged Accounts Receivable assets by following up with 3rd party payers and government agencies on denied, underpaid, or otherwise unresolved accounts (credit balances/variances) and collecting insurance claim balances for the client.

Responsibilities:

• Performs second-tier account follow-up activities in accordance with organizational, client and regulatory guidelines for outstanding insurance receivables including, but not limited to:
  • Performing account follow-up activities on high-dollar accounts receivable
  • Research items requiring further assistance
• Possesses an understanding of the healthcare revenue cycle and applies this knowledge to assist team with achievement of quality control standards
• Demonstrates the ability to professionally communicate with colleagues, payers, and clients (if necessary)
• Ensures accurate and complete account follow-up by demonstrating a thorough understanding of carrier-specific reimbursement as applicable to claim processing to include: eligibility discrepancies, UB-04 and/or 1500 claims form review, DRG, per diem, case rate, fee schedule reimbursements, etc.
• Identifies and communicates A/R trends, payer behavior, workflow inconsistencies or other barriers to account resolution to team and engagement leadership
• Researches and documents any correspondence received related to assigned accounts
• Assess accounts for balance accuracy, confirm correct payer billed, coding accuracy, denials, and outstanding insurance requests
• Provide documentation appropriately and submit corrections; or if payer error, escalate for re-processing in a professional and timely manner
• Identify billing or coding issues and requests re-bills, secondary billing, or corrected bills as needed
• Contacts third party payers and government agencies to resolve outstanding account balances
• Maintains departmental productivity and quality standards and encourages team members to do so as well
• Must posses general PC aptitude and keyboarding ability -- must be able to type at a minimum of 40 wpm required
• Ability to multitask in several applications and systems simultaneously and demonstrates competency with Microsoft Suite and assorted internet browsers required

Education and Experience:

• A minimum of 1-2 years in Healthcare Provider Revenue Cycle experience required
• High School Diploma or equivalent required; Associate's or Bachelor's Degree preferred
• Hands-on experience using Epic, Cerner, Invision, Soarian, McKesson, Allscripts, Meditech, and other industry recognized Revenue Cycle Management Systems required
• Hands-on knowledge of UB-04 and/or HCFA 1500 billing and account follow up, CPT and ICD-10 coding and terminology for hospital and/or ambulatory/physician billing

Physical Requirements:

• While performing the duties of this job, the employee is frequently to use hands, fingers; and frequently to talk or hear. The employee must exert up to 15 pounds of force occasionally (activity or condition exists up to 1/3 of the time), and/or up to 5 pounds of force frequently, and/or a negligible amount of force constantly to move objects. The employee must have the ability to sit for long periods of time.

*This is NOT a front-end billing/collections/patient access position. Applicants should have experience following up with government agencies and commercial payers regarding unresolved insurance claims. Training is focused on coaching experienced staff on client-specific procedures/EMR systems and cannot accommodate new hires performing a career transition.