Accounts Receivable Specialist

Role Description

The main purpose of this position is to support the PHRS mission, vision, core values and customer service philosophy.

• Continuously interact with physicians, patients, and insurance vendors to investigate outstanding claims and incomplete payments.
• Provide first level customer support for billing services, including answering phones and researching patient account issues.
• Maintain proficiency and appropriate level of knowledge with all systems required for task completion.
• Complete patient billing and investigate daily denials by working with insurance vendors and adjusters to resolve problem accounts and re-file open claims.
• Accountable for outstanding customer service to all external and internal clients.
• Develop and maintain effective relationships through effective and timely communication.
• Take initiative and action to respond, resolve, and follow up regarding customer service issues in a timely manner.

Qualifications

• High School diploma or equivalent is required.
• Associates Degree or higher in Medical Billing and Coding or a related field is preferred. A degree is not required if the candidate has at least 2 years of prior billing experience in a physician practice medical billing environment.
• Minimum 2 years of experience in medical billing or has graduated from an accredited medical college.
• Candidate must understand government and managed care payment methodologies and demonstrate knowledge of terms such as contractual adjustment, allowed amount, coinsurance, denial, and denial processes.
• Experience in billing or health insurance claim processing preferred.
• CPT, ICD-9, and HCPCS coding knowledge preferred.
• Knowledge of business office procedures.
• Ability to establish and maintain effective working relationships with patients, physicians, client practice staff, and co-workers.
• Ability to operate a computer, copier, or fax machine.
• Ability to sort and file materials correctly by alphabetic or numeric systems.
• Verbal and written communication skills.
• Knowledge of Microsoft Office Products.
• Experience in one or more of the following billing software platforms is preferred: EPIC, Ideal, Allscripts, Centricity, Acumen-Epic, iSalus, Athena.
• Experience in one or more of the following specialties is preferred: Nephrology, OB/GYN, Gastroenterology, Internal Medicine, Long Term Care.

Requirements

• Required to stay until 6:00 PM EST approximately one time every six weeks, in rotation, with other AR Specialists to cover customer service lines.

Benefits

• Medical, Dental, Vision, STD, LTD, HSA (as applicable with Employer contribution).
• 401k Plan with employer match.

Specific Duties

• Maintain up-to-date patient demographics and insurance information.
• Identify errors through coding, charge entry, and cash application processes.
• Complete daily denials by working with insurance companies and adjusters to resolve problem accounts, re-file and re-open claims, file appeals, and make decisions on adjustments.
• Investigate and work claims based on aging from date of service.
• Refer refund requests to refund specialist.
• Provide first level customer service support for billing services, including answering patient questions and researching account issues.
• Assist with customer pending items including charges, payments, and denials and follow up to confirm these items are resolved.
• Document activity in an accurate and timely manner on the patient’s account.
• Review and prepare accounts for collections.
• Complete and communicate progress on assigned tasks to Manager.
• Maintain proficiency and an appropriate level of knowledge with all systems required for task completion.
• Ensure compliance with all state and federal billing regulations, including HIPAA, and report any suspected compliance issues to the respective Manager or RCM leadership.
• Work with RCM management team to improve processes, increase accuracy, create efficiencies, and achieve the overall goals of PHRS.
• Other duties as assigned.

Work Environment/Other Information

• In office position, with flexibility as to arrival/departure times.
• Remote work option available.
• Proficiency in communication using Teams, Zoom, or Webex.