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Form of workJob Description
KEY RESPONSIBILITIES & DUTIES:
Research and resolve all types of denials efficiently and accurately, which includes but not limited to coordination of benefits (COB), insurance eligibility, coding (e.g., modifiers, diagnoses, edits), billing (e.g., NPI, POS, DOS).
Research and resolve insurance and patient credits timely and accurately.
Follow insurance appeal standards or protocols, establish an appeal correspondence to petition the denial as incorrect or inappropriate and for the third-party carrier to reconsider and adjudicate the claim correctly. May inquire with assigned coder for education or letter of appeal, if outside the scope of the AR Specialist.
Document all actions and communications taken regarding each account/session/encounter in the designated fields in the practice management system (PMS).
Identify and track denial trends by payer, provider, and code.
Identify billing-related issues and work with appropriate internal teams to resolve the identified issue(s) in a timely manner.
Must stay up to date with industry trends and changes that impact Accounts Researching. This may include seminars, training and reading material. It is the employee’s responsibility to maintain one’s AR knowledge and learn specific required areas, such as basic coding.
Ensure secondary claims are filed with the appropriate primary insurance EOB attachment in a timely and accurate manner.
Answer customer service inquiries professionally, timely and efficiently. Make certain the inquiry is completed, closed, or followed up on until closure happens. Document the guarantor/patient’s account in detail.
Handle and expedite distinctive cases including bankruptcy, charity, statements, tax billing document, refunds, and other items, should be processed accurately but expeditiously and follow-through. Follow the designated processes for these distinctive cases.
Collecting outstanding balances must be done professionally and with tact. Posting of payment done accurately, timely and according to protocol.
Handle all claim denials appropriately and according to department standards.
Other duties as assigned.
KNOWLEDGE, SKILLS, AND ABILITIES
Understand basic coding to work coding denials successfully.
Must be able to communicate effectively in English, verbally and written. Additional languages are desirable.
Excellent customer service and phone etiquette skills.
Must be able to maintain a high degree of confidentiality and work well under productivity standards.
Able to prioritize and balance workload on short and long-term company needs.
Must be able to work independently and be able to solve problems efficiently and accurately.
Able to create channels of communication to obtain information necessary to perform job tasks.
Strong organizational skills with the ability to prioritize a high-volume workload.
Helpful attitude, positive teamwork spirit with a willingness to help.
CREDENTIALS/EDUCATION/EXPERIENCE
High School Diploma or Equivalent required.
Minimum of 2 years of experience in medical field/accounting/accounts receivable.
