The Accounts Receivable Specialist is responsible for the entire process of accurate submittal of claims and collection of charges. This includes ensuring that all third party claims are submitted on a timely basis with appropriate responses for insurers. Follow-up of accounts is done consistently. This position reports to Accounts Receivable Supervisor.
- Submits timely and accurate billing and follows-up on collection of medical claims. Follows the billing and collection processes in order to meet or exceed the organization’s financial and operational goals.
- Adheres to timely and accurate problem resolution between the organization and its patients, payor sources, as well as vendors, contractors, and other related business entities.
- Adheres to the billing processes and collection mechanisms and meets or exceeds all requirements for internal controls as well as those from all third party payors.
- Adheres to all billing processes and collection functions and is compliant with all internal policies as well as state, local, and federal laws, regulations, regulatory and/or best practices.
- Ensure all billing and collection efforts contribute to a positive patient experience.
- Possess a positive relationship within and among the medical billing staff, as well as with other departments within the organization.
- Possess a positive working relationship with patients, contractors, vendors, third party payor resources and related entities.
Leadership & Stewardship
- Uphold and consistently represent the values, mission, and policies of the organization at all times.
PRIMARY TASKS AND DUTIES
- Submit claims to the appropriate health plans on a daily basis, review all denials for complexity, make corrections and resubmit claims within 30 days of the denial received date.
- Complete claim forms, submit bills and claims, perform quality control procedures on all claim forms and detail bills to ensure accurate billing.
- Contact vendors regarding denials or benefit coverage.
- Verify insurance benefits.
- Responsible for running billing reports.
- All other duties as assigned.
ESSENTIAL FUNCTIONS/KEY COMPETENCIES
- Demonstrate knowledge and expertise in medical claims and billing.
- Demonstrate interpersonal savvy and influence skills in all dealings with regulatory agencies, government entities, network providers, and related concerns.
This position requires compliance with Chesapeake Health Care. Requirements of Conduct/Work Rules, Compliance Program, and policies and procedures. Failure to comply, which may include the failure to report any conduct or event that potentially violates legal or compliance requirements of our written standards, will be met by the enforcement of disciplinary action, up to and including possible termination, in accordance with our compliance program policy and procedures.
- High school diploma or equivalent
- Experience and expertise in billing and record keeping.
- Demonstrated experience and significant knowledge of contract insurance, HMO’s, PPO’s, Medicare, etc.
- Demonstrated analytical skills and aptitude for solving problems.
- High level of communication and customer service skills
- Ability to interact with computer screen for up to six hours at a time (visual acuity required).
- Must have manual dexterity for use of keyboard. Ability to remain stationary for periods of up to four hours. Ability to communicate via phone, mail and in person to resolve disputes, solve problems, etc.
- Cognitive skills to analyze, calculate, problem solve issues related to invoices, billing, and other relevant matters associated with the invoicing and billing processes.
- Normal overtime/extended work hours
Job Type: Full-time
- Medical Billing And Coding: 1 year
- Medical Billing: 2 years