Accounts Receivable Specialist

Ensemble Health Partners

Accounts Receivable Specialist:

Responsible for following up directly with commercial and governmental payers to resolve claim issues and secure appropriate and timely reimbursement.
Identifies and analyzes denials and payment variances and takes action to resolve account including drafting and submitting technical appeals.
Examines denied and underpaid claims to determine reason for discrepancies.
Communicates directly with payers to follow up on outstanding claims, file technical appeals, resolve payment variances, and ensure timely reimbursement.
Ability to identify with specific reason underpayments, denials, and cause of payment delay.
Works with management to identify, trend, and address root causes of issues in the A/R.
Maintains a thorough understanding of federal and state regulations, as well as payer specific requirements and taken appropriate action accordingly.
Documents activity accurately including contact names, addresses, phone numbers, and other pertinent information.
Demonstrates initiative and resourcefulness by making recommendations and communicating trends and issues to management.
Needs to be a strong problem solver and critical thinker to resolve accounts.
Must meet productivity and quality standards.
Performs other duties as assigned

Minimum Years and Type of Experience: High School Diploma

Other Knowledge, Skills and Abilities Required:

Must demonstrate basic computer knowledge and demonstrate proficiency in Microsoft Excel.
Must pass typing test of 35 words per minute (error adjusted).
Excellent Verbal skills.
Problem solving skills, the ability to look at account and determine a plan of action for collection.
Critical thinking skills, the ability to comprehend tools provided for securing payment, and apply them to differing accounts to result in payment.
Adaptability to changing procedures and growing environment.

Other Knowledge, Skills and Abilities Preferred:

2 or 4 year degree.
1-3 years of relevant experience in medical collections or professional billing preferred.
Knowledge of claims review and analysis.
Working knowledge of revenue cycle.
Experience working the DDE Medicare system.
Working knowledge of medical terminology and/or insurance claim terminology.
Certifications: CRCR within 6 months hire.

Scheduled Weekly Hours: 40

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