AR Collections Specialist

Ar Collections Specialist

The AR Collections Specialist is responsible for following up in a timely fashion on claims that have been paid incorrectly or have not been paid. They are responsible for communicating with the field and their supervisor any issues preventing a claim from being sent to the payer. They are also responsible for sending claims to the payer in a timely and accurate manner.

To perform this job successfully, an individual must be able to satisfactorily perform each essential function listed below:

• Updates collection procedures as necessary
• Reviews and works denials in workflow system daily
• Reviews and works denials in payer portal and/or clearinghouse portal daily
• Reviews and works in denial workflow system for tasks with follow-up dates that are set to expire on that day
• Reviews and works in denial workflow system for tasks without a payer response once past 30 days from billing
• Follows up with Field on updates to items assigned to them that are past the follow-up date
• Updates denial workflow system with clear, concise notes as claims are worked
• Notifies Field of denials that require their attention
• Notifies biller when claims can be electronically rebilled
• Sends out paper or complete web portal billing once any necessary corrections have been made
• Communicates with Field Finance and SSC Management on issues with collections
• Reviews unapplied cash log for any items that can be applied and works with cash team to resolve
• Works credit balances on the aging and overpayment account and follows the credit balance procedure for resolution
• Prepares appeal packet as required by payer, scans and save documentation to be sent, updates denial workflow system with notes and follow-up date, and have Supervisor review prior to sending
• Follows-up on appeal status with payer after 30 days and then on a bi-weekly basis until paid
• Completes necessary forms and provides appropriate support for:
• Refunds
• Cash move
• Sales adjustments
• Transfer of Liability
• Ensures internal control compliance with all assigned areas and other audit requirements
• Assists in the onboarding of new hires by providing required training when necessary
• Embraces concept mentoring by actively participating in team meetings and fostering an environment in which team members proactively collaborate with one another
• Proactively supports management as well as the objectives and goals of the department
• Supports special projects, mission-critical initiatives, and performs other duties as assigned by the Supervisor
• Ensures Sarbanes-Oxley compliance with all assigned areas and other audit requirements.
• Responsible for the maintenance of an effective control environment under SOX 404 for the accounting operations he or she oversees. This includes both key and non-key controls and extends to the timely updating and modification of control design where necessary and the oversight of control remediation activities should exceptions be encountered in testing.
• System testing
• Performs other related duties and activities as required

Minimum Knowledge and Skills Required by the Job:

The requirements listed below are representative of the knowledge, skill, and/or abilities required to perform the job:

Education and Experience:

• High school diploma or equivalent
• Associates or Bachelor's degree in a Finance related field preferred
• Two to three years of experience with Medical Collections in a high volume environment preferred
• Knowledge of ICD-10 diagnosis codes and CPT medical service codes
• Knowledge of UB-04 and HCFA-1500 forms
• Strong understanding of medical collections compliance
• Strong understanding of Medicare, Medicaid, Medicaid managed care, Commercial, Workers Comp and Auto-no-fault payer types

Other Skills and Abilities:

• Must be self-motivated and detail oriented
• Must have excellent communication skills
• Must be highly organized with ability to multi-task
• Must have analytical skills and the ability to collect information from different sources
• Effectively use Microsoft Office (Word, Excel, PowerPoint, Outlook, etc.)

Other Requirements:

• The regular working hours for this position can be performed remotely; however, due to current business and employment requirements, we are unable to employ individuals in this role who will be working from Alaska, Hawaii, New York, Oregon, South Dakota, Vermont, Washington State, or Washington, D.C. Although the role is primarily remote, occasional in-person and related travel is an essential function of this position.

Physical Requirements:

• Sedentary work. Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Americans with Disabilities Act Statement:

External and internal applicants, as well as position incumbents who become disabled, must be able to perform the essential job functions either unaided or with assistance of a reasonable accommodation to be determined on a case by case basis via the interactive process.