Accounts Receivable Clerk

Accounts Receivable Representative

The Accounts Receivable Representative will:

• Ensure account accuracy.
• Review daily claims to ensure submissions are clean and timely.
• Monitor charges/modifiers/CPT-4s/HCPCS/payments/DRGs/ICD-10 coding.
• Review outstanding accounts using ATB/queues/payments reports/halt report/electronic billing edits/credit balances.
• Submit timely and accurate adjustments/notes/patient balance transfers and medical record requests.
• Work with management team and notifying of notifying of issues that arise with payors/departments/etc.
• Resolve account issues and problem solving independently whenever possible.
• Use technology provided (including hospital information system, contract management system, electronic billing system, payer websites and document imaging system.)
• Manage denials and appealing administrative claims.
• Understand denials and how they should be handled.
• Send clinical denials and downgraded claims to appropriate parties to ensure timely appeal.
• Ensure claims denied at time of billing are distributed to appropriate parties for review.
• Update and correct accounts with assistance of originating departments (charges/authorizations/insurance issues).
• Follow departmental and hospital policy and procedure (this includes HIPAA guidelines and Federal guidelines).
• Understand payor contracts and billing guidelines; revenue codes and payor specific requirements; and payor/plan codes.

Requirements:

• Requires one (1) or more years experience as a Medical Insurance Biller or related responsibilities and Hospital Billing strongly preferred.
• Proficient in Microsoft Word and Microsoft Excel.
• Requires high level of interpersonal skills necessary to lead others and to work effectively with Patient Accounts Personnel as well as outside agencies.
• Must possess a comprehensive knowledge of Collection, A/R follow-up and Billing. Knowledge of third-party payers, State and Federal Agencies (constantly changing) with regards to Patient Accounting.
• Requires the ability to consistently meet deadlines, to concentrate and pay attention to details 75% of work time.