POSITION SUMMARY:

Under the direction of the Supervisor, Accounts Receivable, the Accounts Receivable Specialist is responsible for resolution of patient account balances associated with insurance denials, answer incoming insurance and practice calls with the ability to explain charges, services and insurance billing questions. Work with practices and payers to resolve claim denials and comply with insurance and all relevant procedures, guidelines, and policies.

KEY RESPONSIBILITIES:

• Responsible for various aspects of medical billing: claim creation, claim submission, payment posting for insurance, and patient balances. These denials and appeals are billed in the AthenaNet system electronically.
• Obtains supporting documentation; i.e., medical records, EOBs, Remits, Authorizations, referrals, etc., through our email applications, scanning system, Medicare remittance system, and Meditech (hospital billing system).
• Reviews, interprets and applies contractual terms and identifies and/or applies contractual and administrative adjustments.
• Monitor insurance denials by running reports and contacting insurance companies to resolve and recover denied claims.
• Monitors aging reports for timely follow-up on unpaid claims.
• Performs retroactive review of registration data to aid in the assurance of clean claim submittal.
• Accurately documents claim actions taken within patient account/claims.
• Serves as a resource for problem solving issues related to registration, demographic, and insurance errors.
• Works payer correspondence including support tickets, emails, and phone messages from internal and external contacts.
• Works collaboratively with Coding, Provider Enrollment, and Cash Posting team as well as coworkers, Team Leads, Managers, and practice staff to resolve claim and account issues.
• Assists Patient Accounts Team as needed with incoming and outgoing patient calls to resolve and collect on a patient statement.
• Adheres to the HIPAA guidelines regarding confidentiality relating to the release of financial and medical information.
• Additional duties as assigned by Manager.

REQUIRED KNOWLEDGE & SKILLS:

• Strong knowledge on third party payers guidelines and procedures required.
• Experience and/or knowledge of insurance denials process.
• Health care claims processing and follow-up background.
• Billing experience and insurance knowledge (eligibility, registration, etc.)
• Must have knowledge of ICD-10 and CPT-4 coding.
• Prior experience with AthenaNet billing system is strongly preferred.
• Customer / Patient Account Services Skills.
• Drives results while balancing multiple priorities and tasks.
• Attention to detail.
• Strong verbal and written communication skills.
• Possess strong analytical skills and computer skills including Outlook, Excel, and Word.
• Computer skills are required.

EDUCATION/EXPERIENCE/LICENSURE:

I. Education: Associates Degree in Business, Accounting or Finance preferred.
II. Experience: 1-2 years of related experience required.
III. Certification: Certified Biller preferred.