Insurance Medical A/R Specialist II -Must have 3 years experience
JOB DESCRIPTION
The Insurance Medical A/R Specialist II is responsible for the management of outstanding insurance accounts through written or verbal direction from insurance carriers for the accurate and timely filing of claims for maximum reimbursement and posting rejections with accurate explanations and responsible for filing appeals and reconsiderations. Insurance A/R Specialist duties include being familiar with payer websites, denials, rejections and answering patient balance inquiries and providing outstanding customer service. This position is Hybrid must be willing to commute to the office.
Essential Functions
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Thoroughly research reasons for denied & rejected claims and work appeals as necessary to resolve outstanding balances
- Responsible for resolving denials/appeals in the Hold bucket within 72 hours of receipt
- Review previously worked claims within a minimum of 30 days
- Responsible for the accurate and timely resolution of professional billing claim and clearinghouse edits as well as payer rejections
- Responsible for resolving claims that are greater than 60 days from date of service
- Work a minimum of 50 claims a day
- Communicate effectively with the Coders to handle the accurate and timely resolution of coding- related claim edits and appeals
- Identify and document new payer denial trends, and notify supervisor for escalated follow up
- Manage patient and payer credit balances with established policy and procedures
- Answer phone calls regarding billing inquiries and resolve billing issues in a polite and confident manner
- Create collections works lists and submit for provider approval
- Assist with charge entry back log
- Other duties as assigned
Competencies
- Problem Solving/Analysis
- Familiar with payer websites
- Familiar with appeals/reconsiderations for denied claims
- Organizational Skills
- Customer/Client Focus
- Time Management
- Results Driven
- Initiative
Required Education and Experience
- High School Diploma or equivalent
- Good understanding of Medicaid, Medicare and Commercial Insurance
- Practice management software experience
- Knowledge CPT and ICD 10 coding, and medical terminology
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for their job. Duties, responsibilities, and activities may change at anytime.
Expected Hours of Work
This is a full-time position and hours of work and days are Monday through Friday, 8 a.m. to 5 p.m.
Work Environment
This job operates in a professional office environment. This role routinely uses standard office equipment.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms. This position requires the ability to occasionally lift office products and supplies, up to 20 pounds.
AAP/EEO Statement
Austin Health Partners is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Job Type: Full-time
Pay: $20.00 - $25.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Ability to Commute:
- Austin, TX 78730 (Required)
Work Location: Hybrid remote in Austin, TX 78730
