AR Specialist

Accounts Receivable Specialist

The Accounts Receivable Specialist provides good judgement in evaluating patient accounts and taking appropriate action pertaining to compliant billing and collections as necessary to assure timely payments or other disposition of patient accounts.

Requires prolonged sitting, some bending, stooping and stretching and standing, hand-eye coordination and manual dexterity to operate keyboard, photocopies, telephone, office equipment. Requires normal range of eye sight, hearing and aptitude to record, prepare, and communicate appropriate information and reports.

Performance Expectations

• Perform consistent, assertive, efficient and timely follow-up on accounts as determined by Management, which means maintaining minimum A/R performance according to MGMA Standards of higher.
• Assist in the increase of cash collection and the decrease of Accounts Receivables (AR) aging for designated plan(s) using effective and efficient collection techniques, including, but not limited to, the use of individual plan(s) escalation and/or appeal processes, patient and/or physician contact.
• Able to understand and effectively interpret payer contracts, Remittance Advices (RA) and Explanation of Benefits (EOB) statements.
• Medicare, Medicaid, and/or Third Party Payer experience in dealing with healthcare insurance companies through phone follow-up and letter correspondence during the appeals or denial resolution process.
• Demonstrates a working knowledge of the medical health insurance benefits provided by assigned payers and able to consistently and accurately explain these to patients.
• Corrects billing errors, edits, overlaps, etc., and submit clean claims electronically or on paper to be mailed on a daily basis as required, using the practice's third party claim editor systems. (Practice Plus and Trizetto).
• Demonstrates knowledge of insurance and billing forms and the ability to investigate and resolve debit and credit account balances.
• Document relevant activity in account notes in a clear and succinct manner in order to present clear and concise claim work reports to Management.
• Review payment variances and remittances for resolution in an efficient and timely manner for processing of patient and/or insurance refunds. Respond in a timely manner to a High Dollar Account Specialist, Patient Collector Analyst or Management regarding high dollar or complex accounts.
• Identify payer issues or trends and update Manager in a timely manner, providing concrete examples for Management to review.
• Utilizes patient chart on an as needed basis, accessing only information related to treatment, payment, and health operations.
• Maintains and adheres to the company's HIPAA, Compliance, and OSHA regulations.
• Other duties as assigned.

Certificate/License

Certification in Medical Coding a plus.

Certified Patient Service Specialist (CPSS), obtained within 6 months of hire date.

Job Qualifications

1. High School Diploma 2. Previous experience in a medical group practice environment preferred. 3. Experience in medical accounts receivable, claims appeal, and coding prefer.

Company provides a comprehensive benefits package including Medical, Dental, Vision, Life, Long-Term Disability and Supplemental policies, Paid Time Off, 401k plan with company matching and uniform allowance.