Ventra Health
Overview
Job Summary:
- Accounts Receivable Representatives 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
Qualifications
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
“This job can be performed remotely anywhere in the United States with the exception of California, Colorado, or New York.”
