Accounts Receivable Specialist

Accounts Receivable Specialist

The Accounts Receivable Specialist is responsible for filing insurance claims, denial management and adjudication according to LBJI contracts.

Essential Job Functions

• Review accounts receivable reports daily.
• Manage patient account(s) to ensure accurate and timely filing of all claims.
• Research unpaid and denied insurance claims in an expeditious manner to ensure account resolution and claim payment.
• Verify accuracy and completeness of documentation included with paper claims prior to submission.
• Initiate appeals and/or refile claims for all denials.
• Request refunds according to LBJI policies and guidelines.
• Organize and gather medical billing upon requests from insurance companies, attorney offices, and audit contractors.
• Obtain retro authorizations as needed.
• Function as internal resource for staff questions.
• Have an in-depth understanding of insurance rules and regulations, CPT/ICD10 coding information, explanation of benefits and company billing procedure(s).
• Develop and establish network connections with insurance provider representative(s) as well as other critical department(s) within insurance carriers(s).
• Communicate with team member(s) and the Billing Manager regarding billing issue(s), insurance process(es) and denial trends. Present problems to team with a solution-based approach.
• Coordinate with insurance carriers to obtain electronic payments and remittances for payments to LBJI.
• Meet and respond to patient requests for assistance and/or questions regarding financial accounts, insurance payment and patient balances.
• Review insurance carrier newsletters, mail announcements and share updates with the billing department and A/R Specialist Supervisor.
• Maintain confidentiality and compliance with HIPAA rules and regulations.
• Attend meetings as required.
• Other duties as assigned.

Physical Requirements

While performing the duties of this job, the employee may be required to sit and/or stand for prolonged periods, work longer than eight (8) hour shifts, and to work both day/evening shifts. Work may hand dexterity as well as the need to reach, climb, balance, stoop, kneel, crouch, talk, and hear. The employee must occasionally lift and/or move up to 50 lbs. While performing the responsibilities of the job, the employee is required to talk and hear. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to focus. Reasonable accommodation can be made to enable people with disabilities to perform the described essential functions of the job.

Work Environment

Work is performed in an office environment. Involves frequent personal and telephone contact with patients, physicians, and other healthcare personnel. Work may be stressful at times. Interaction with others is constant and interruptive. Work may involve interaction with injured or sick patients.

Travel between all Lakeshore Bone & Joint facilities as needed.

Qualifications

• High school diploma or the equivalent
• Minimum of 2-year medical insurance experience preferred.
• Knowledge of CPT and ICD-10 codes
• Knowledge of Explanation of Benefits

Required Skills

• Proficiency in Microsoft Word, Excel, and Outlook.
• Digital literacy.
• Employ critical thinking and problem solving.
• Ethical reasoning and decision making
• Strong attention to detail
• Receptive and responsive to feedback
• Excellent verbal and written communication skills
• Time management, prioritization, and sense of urgency
• Maintain patient confidentiality.

Equal Employment Opportunity & Accommodation Statement

Lakeshore Bone & Joint is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.