AR Collections Specialist

OUR MISSION AND PERFORMANCE EXPECTATIONS

Sevita is a mission-based organization dedicated to providing high-quality services to those we serve. To deliver on our mission, every employee is expected to perform their role in accordance with the Company's mission and values.

SUMMARY

The AR Collections Specialist is responsible for timely follow-up on claims that have been paid incorrectly or remain unpaid. This role communicates with the field and leadership regarding issues preventing claims from being submitted, ensures claims are billed accurately and promptly, and works to resolve outstanding accounts.

ESSENTIAL JOB FUNCTIONS

To perform this job successfully, an individual must be able to satisfactorily perform each of the following essential functions:

• Update collection procedures as needed.

• Review and resolve denials daily through the Denial Workflow System, payer portals, and clearinghouse portals.

• Review and work tasks in the Denial Workflow System that are due for follow-up.

• Review and work claims in the Denial Workflow System with no payer response after 30 days from billing.

• Follow up with field staff on assigned items that are past their follow-up date.

• Document claim activity with clear, concise notes in the Denial Workflow System.

• Notify the field of denials requiring action.

• Notify billers when claims are eligible for electronic rebilling.

• Submit corrected paper claims or web portal claims after required corrections have been completed.

• Communicate collection issues with Field Finance and Shared Services Center (SSC) Management.

• Review unapplied cash logs, identify items that can be applied, and work with the cash team to resolve outstanding items.

• Resolve credit balances on aging and overpayment accounts in accordance with established credit balance procedures.

• Prepare appeal packets as required by the payer, scan and save supporting documentation, document activity in the Denial Workflow System, obtain supervisory review prior to submission, and follow up with the payer after 30 days and every two weeks thereafter until payment is received.

• Complete documentation and provide support for:

• Refunds

• Cash moves

• Sales adjustments

• Transfers of liability

• Ensure compliance with internal controls and audit requirements in all assigned areas.

• Assist with onboarding and training new team members as needed.

• Actively participate in mentoring, team meetings, and fostering a collaborative team environment.

• Support management, departmental objectives, special projects, mission-critical initiatives, system testing, and other duties as assigned.

• Ensure compliance with Sarbanes-Oxley (SOX) requirements in all assigned areas.

• Maintain an effective SOX 404 control environment for assigned accounting operations, including key and non-key controls, updating control designs when necessary, and supporting remediation activities when exceptions are identified during testing.

• Perform system testing.

• Perform other related duties and responsibilities as assigned.

SUPERVISORY RESPONSIBILITIES

• None required.

MINIMUM KNOWLEDGE AND SKILLS REQUIRED

Education and Experience

• High school diploma or equivalent required.

• Associate's or Bachelor's degree in Finance, Accounting, Business, or a related field preferred.

• Two to three years of medical collections experience in a high-volume environment preferred.

• Michigan insurance collections experience is preferred but not required.

• Auto insurance no-fault collections experience is preferred but not required.

• Knowledge of ICD-10 diagnosis codes and CPT medical service codes.

• Knowledge of UB-04 and HCFA-1500 claim forms.

• Strong understanding of medical collections compliance.

• Strong knowledge of Medicare, Medicaid, Medicaid Managed Care, Commercial, Workers' Compensation, and Auto No-Fault payer types.

Certificates, Licenses, and Registrations

• None required.

Other Skills and Abilities

• Self-motivated with strong attention to detail.

• Excellent verbal and written communication skills.

• Highly organized with the ability to manage multiple priorities.

• Strong analytical and problem-solving skills with the ability to gather information from multiple sources.

• Proficient in Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook.

Other Requirements

• Travel as needed.

PHYSICAL REQUIREMENTS

Sedentary work requiring occasional exertion of up to 10 pounds of force and/or negligible force frequently to lift, carry, push, pull, or otherwise move objects, including the human body. This position primarily involves sitting, with occasional walking and standing as required to perform essential job functions.

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.

Sevita is a leading provider of home and community-based specialized health care. We believe that everyone deserves to live a full, more independent life. We provide people with quality services and individualized supports that lead to growth and independence, regardless of the physical, intellectual, or behavioral challenges they face.

We've made this our mission for more than 50 years. And today, our 40,000 team members continue to innovate and enhance care for the 50,000 individuals we serve all over the U.S.

As an equal opportunity employer, we do not discriminate on the basis of race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age, disability, genetic information, veteran status, citizenship, or any other characteristic protected by law