Overview
Job Summary:
The Medical Accounts Receivable (“AR”) Specialists are primarily responsible for analyzing collections, resolving non-payables, and handling bill inquiries for more complex issues. AR Representatives are responsible for insurance payer follow-up ensuring claims are paid according to client contracts. Complies with all applicable laws regarding billing standards
Responsibilities
Essential Functions and Tasks:
Follows up on claim rejections and denials to ensure appropriate reimbursement for our clients
Process assigned AR work lists provided by the manager in a timely manner
Write appeals using established guidelines to resolve claim denials with a goal of one contact resolution
Identified and resolved denied, non-paid, and/or non-adjudicated claims and billing issues due to coverage issues, medical record requests, and authorizations
Recommend accounts to be written off on Adjustment Request
Reports address and/or filing rule changes to the manager
Check system for missing payments
Properly notates patient accounts
Review each piece of correspondence to determine specific problems
Research patient accounts
Reviews accounts and to determine appropriate follow-up actions (adjustments, letters, phone insurance, etc.)
Processes and follows up on appeals. Files appeals on claim denials
Scan correspondence and index to the proper account
Inbound/outbound calls may be required for follow up on accounts
Route client calls to the appropriate RCM
Respond to insurance company claim inquiries
Communicates with insurance companies for status on outstanding claims
Meet established production and quality standards as set by Ventra Health
Performs special projects and other duties as assigned
Education and Experience Requirements:
High School Diploma or GED
At least one (1) year in data entry field and one (1) year in medical billing and claims resolution preferred
AAHAM and/or HFMA certification preferred
Experience with offshore engagement and collaboration desired
Qualifications
Knowledge, Skills, and Abilities:
Intermediate level knowledge of medical billing rules, such as coordination of benefits, modifiers, Medicare, and Medicaid and understanding of EOBs
Become proficient in use of billing software within 4 weeks and maintain proficiency
Ability to read, understand, and apply state/federal laws, regulations, and policies
Ability to communicate with diverse personalities in a tactful, mature, and professional manner
Ability to remain flexible and work within a collaborative and fast paced environment
Basic use of computer, telephone, internet, copier, fax, and scanner
Basic touch 10 key skills
Basic Math skills
Understand and comply with company policies and procedures
Strong oral, written, and interpersonal communication skills
Strong time management and organizational skills
Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills
Base Compensation:
Base Compensation for this position: $16.00 – $20.00 per hour
Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons
This position is also eligible for discretionary performance bonuses in accordance with company policies
