The 3rd Party Accounts Receivable Representative is responsible for preparing, submitting and following up on Healthcare claims to ensure timely reimbursement, eligibility verification, and working claim denials.
- Prepare, edit and submit account billing in accordance with payer guidelines. Ensure all claims issues are resolved and submitted accurately and timely per insurance guidelines.
- Follow payer contract guidelines set forth for specific payers.
- Analyze and review reimbursement rates to ensure proper reimbursement is being made based on fee schedules and contracted rates.
- Review and understand payer denials and identify payer trends.
- Verify patient’s insurance eligibility.
- Submit system payer/fee schedule changes when required to supervisor.
- Submit all required documentation with claim. Updates patient demographics changes and performs required rebilling. Requests necessary documentation when missing from client, physician or patient as appropriate.
- Respond to verbal and written insurance or responsible party inquiries regarding account status within policy and procedure timeline. Research accounts and document follow up appropriately.
- Resolve account discrepancies and prepare adjustments and refunds for approvals as necessary.
- Maintain accurate and complete records concerning billing activity on all accounts. Document in the system records.
- Address problems as they occur. Keep supervisor advised of area or compliance issues which may lead to untimely or inaccurate completion of invoice or claim submission.
- Heavy Phone Calls to payers to understand denials and trends
- Complete all reports according to schedule.
- Perform other tasks as assigned to support the goals of the organization.
- To be able to work independently.
- At this time this position will work remote from home due to COVID-19 however this position may return to the business office.
- To work remote, you will need high speed internet and be able to pass speed test.
Required
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1 year(s): Medical Billing
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1 year(s): Revenue Cycle
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1 year(s): CMS1500 Claim Processing
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2 year(s): HealthCare Accounts Receivable
Required
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Medical Terminology
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Computer Skills
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Identify/Resolve Problems
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Typing Skills - 10 Key
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Communication Skills
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Customer Service
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Microsoft Office
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Typing Skills Min 35 wpm
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Claims Processing
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Time Management
Preferred
Required
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Dedicated: Devoted to a task or purpose with loyalty or integrity
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Thought Provoking: Capable of making others think deeply on a subject
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Enthusiastic: Shows intense and eager enjoyment and interest
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Team Player: Works well as a member of a group
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Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well
Preferred
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Work-Life Balance: Inspired to perform well by having ample time to pursue work and interests outside of work
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Financial: Inspired to perform well by monetary reimbursement
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Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization
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Goal Completion: Inspired to perform well by the completion of tasks
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Self-Starter: Inspired to perform without outside help
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.
