Accounts Receivable Specialist

Accounts Receivable Specialist

The Accounts Receivable Specialist is responsible for maintaining the life of a claim which includes the following: Claims Submission and Processing, Charge Entry, Claim Edit, DNB, Stop Bills, Claim Rejection, Denial Management, Accounts Receivable Follow-up, No Response, Compliance and Billing Regulations, Variance, Correspondence and Credit Balance Resolution. The Accounts Receivable Specialist communicates with the insurance carriers to ensure appropriate and compliant payment of services via telephone, email, fax, payor website. This position reviews reports to determine trends and discusses with management to help resolve front-end errors, reviews and follows up on all claims not paid by carriers in a timely manner and claims not paid appropriately.

Essential Functions and Responsibilities:

• Proactively contributes to Eskenazi Health's mission: Advocate, Care, Teach and Serve with special emphasis on the vulnerable population of Marion County.
• Models Eskenazi Health values of Professionalism, Respect, Innovation, Development and Excellence.
• Assist customer service with follows up on patient calls within a timely manner.
• Maintains department weekly production and monthly quality measures.
• Communicates effectively and appropriately with internal and external customers.
• Acts independently seeking guidance when necessary to remain compliant with federal, state, and hospital policies relative to insurance patient billing.
• Initiates proper course of action for problem solving resolution.
• Analyzes all claim denials to determine the best course of action to resolve any issue and receive appropriate payment.
• Verifies and updates claims with insurance and demographic information when changes are needed.
• Resolves inquiries from internal and external customers.
• Takes active role in special projects as requested.
• Gathers and distributes insurance information obtained through verbal and/or written communication for the purpose of maintaining sufficient cash flow.
• Analyzes and resolves issues reported from the self-pay outsource vendor.
• Utilizes interpersonal communication strategies/skills to achieve desired outcome/results with patients/families and others.
• Provides coverage for co-workers as necessary due to PTO/illness.
• Continuing knowledge-based learning on payor guidelines and requirements for appropriate billing.
• Enter daily charges for NTP clinic.
• Works charge review in a timely and accurate manner to ensure appropriate billing of services.
• Investigate and Resolves claim edits, rejections (internal/external), DNB, Stop Bills, follow up, variance, monitoring status of denials, denials, appeals, credit balance resolution and correspondence.
• Work queue management for better efficiency of work flows i.e. filters and rules.
• Follows up on unpaid claims with insurance companies.
• Initiate Billing/Charge Review resolution.

Job Requirements:

• Associate Degree in business-related field or technical training in coding and/or billing in lieu of Three years of experience in medical practice/hospital setting with billing, insurance follow-up and/or credit balance experience.
• CPC Certification a plus
• Dental, Vision, Behavioral Health and/or DME experience a plus

Knowledge, Skills & Abilities:

• Pays close attention to detail with accuracy in record keeping and documentation.
• Identifies trends with denials (providers/locations/carriers) and works with management to help educate or resolve errors from the start and avoid back-end denials.
• Willingness and ability to assist other team members.
• Excellent problem-solving skills and ability to cooperate with others.
• Works independently and efficiently.
• Working knowledge of Microsoft Office Software, Windows.
• Utilizes calculator, printers, copiers, and fax machines.
• Strong math skills.
• Strong organizational skills and ability to work efficiently in a high volume, multi-task environment meeting deadlines.
• Uses professional and appropriate communication skills.
• Advanced understanding of health insurance medical policy and billing requirements, including government and managed care programs as well as traditional Medicaid, Medicare replacement plans, commercial carriers, HIP, Anthem.
• Ability to meet production and accuracy requirements outlined by department goals.

Eskenazi Health's programs have received national recognition while also offering new health care opportunities to the local community. As the sponsoring hospital for Indianapolis Emergency Medical Services, the city's primary EMS provider, Eskenazi Health is also home to the first adult Level I trauma center in Indiana, the first verified adult burn center in Indiana and Sandra Eskenazi Mental Health Center, the first community mental health center in Indiana, just to name a few.

Health & Hospital Corporation