Purpose of Position: Results-driven Accounts Receivable (AR) Follow-Up Specialist with expertise in physician and provider billing, responsible for the proactive management, investigation and resolution of outstanding accounts receivables. Ensure timely reimbursement through detailed claim analysis, denial management, and payer follow-up while maintaining compliance with regulatory and payer guidelines.
:
1. Conduct comprehensive follow-up on outstanding physician and provider claims to ensure timely resolution and reimbursement.
2. Analyze aged AR, identify trends, and prioritize accounts based on age, financial impact and payer requirements.
3. Reconcile account balances utilizing remittance advice, explanation of benefits and payer correspondence.
4. Investigate, resolve and prevent claim denials through root cause analysis and collaboration with internal departments.
5. Prepare and submit timely, compliant appeals with supporting clinical and billing documentation.
6. Track and manage denial workflows using payer systems and internal denial management tools.
7. Review claims for billing accuracy to ensure compliance with payer policies.
8. Serve as a liaison between providers, payers, and patients to resolve billing discrepancies and payment delays.
9. Communicate professionally with insurance carriers regarding claim status, underpayments and appeals.
10. Respond to inquiries while ensuring HIPAA compliance and service excellence standards.
11. Maintain working knowledge of CPT, HCPCS, ICD-10-CM, modifiers, occurrence codes, condition codes, span codes, and value codes applicable to assigned payer groups to effectively carry out the responsibilities of assigned insurance group(s).
12. Identify underpayments, missed revenue opportunities, and process improvements within the professional revenue cycle.
13. Support initiatives to enhance cash flow and reduce days in A/R.
14. Verify insurance information through eligibility verification, claim status review, payer portals, and individual insurance carrier websites.
15. Perform follow-up activities on unpaid accounts utilizing trial balances, payer correspondence, online portals, and other reports and claim listings as appropriate.
16. Calculate patient liability and perform system adjustments to support accurate patient statement billing as needed.
17. Monitor credit balance reports and performs analysis making appropriate claims adjustments and/or refunds as necessary.
18. Create and maintain logs and reports as needed to support Patient Account activities.
19. Provide cross-coverage and support for departmental operations, including training activities and coverage during staff absences.
20. Comply with departmental and organizational policies including but not limited to dress code, use of supplies, phones and computers.
21. Adheres to work schedules and maintains a safe and orderly work area at all times, maintaining awareness of and compliance with safety policies and procedures.
22. Attends and participates in educational programs, in-service meetings, workshops, and other activities as related to job performance, job knowledge and state regulations.
23. Analyze automated billing system output and reports to identify, research, and resolve outstanding accounts.
24. Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers.
25. Performs other job-related duties and assignments as requested.
:
- Must read, write, and communicate in English
- High School diploma or GED
- (Preferred) Associate's or Bachelor's degree in Business, Healthcare Administration, or related field. Relevant healthcare experience may be considered in lieu of formal education.
- Minimum of one (1) year of experience in professional/physician medical billing, including accounts receivable follow-up, denial management, and claim resolution.
- Experience with electronic billing systems and payer portals
- Working knowledge of professional billing workflows, CPT, HCPCS, and ICD-10-CM coding conventions, modifiers, medical terminology, and insurance billing guidelines.
- Knowledge of HIPAA regulations
- Proficiency with Microsoft Excel, Word, and Outlook
- Strong analytical, organizational, and problem-solving skills, with exceptional attention to detail and the ability to manage multiple priorities in a fast-paced environment.
- (Preferred) Experience using Epic or comparable electronic billing software
Schedule Details: 40 hrs. per week, Mon-Fri, No Weekends & No Holidays
: Cape Cod Healthcare, Inc.
: Massachusetts-Hyannis
Department: HCI-Revenue Cycle Physicians
Annual/Hourly: Unassigned
Hiring Pay Range: $0 - $0
