Position: Accounts Receivable Specialist
Reports to: Sr. RCM Manager
Job Description:
Accounts Receivable Specialist with a minimum of two to four years’ experience in insurance collections for claims adjudication. Will manage a portfolio of assigned treatment centers and will be required to contact insurance companies for the purpose of claims processing in a timely manner. The Specialist is expected to work a minimum of 25 to 30 claims per day.
Duties will include telephone contact with insurance carriers as well as their internet web sites (Portals) for claims resolution. Additionally, be able to problem solve on next steps on claim denials. Various collection actions include claims resubmission, corrected claims and appeals. Accounts must be worked accurately in accordance with office standards. Queues need to be worked daily and in a timely manner. Adherence to HIPPA confidentiality is required.
Summary of Essential job duties:
- Understanding of Commercial, Medicare, Medicaid and third-party billing processes.
- Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other third-party payer requirements and systems.
- Effective communication abilities for phone contacts with insurance payers to resolve issues.
- Documents all collection activity on accounts.
- Review explanation of benefits in making sure claims were paid correctly; based on fee schedule for payer.
- Problem-solving skills to research and resolve discrepancies, denials, appeals, collections. A calm manner and patience working with insurers during this process.
- Review claims before closing out adjustments.
- Familiar with CPT and ICD-10 coding.
- Competent use of computer systems and software.
- Ability to work well in a team environment. Being able to delegate tasks, and handle conflict in a reasonable manner.
- Ability to multi-task.
- Maintaining patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
