Lead Account Reimbursement Specialist

Job Description

Job Description

Lead Account Reimbursement Specialist III

Job Summary:
The Lead Account Reimbursement Specialist III facilitates the revenue cycle process by providing day to day operational support to billing, follow up, and customer staff. Serves as the liaison between clinical departments, Patient Financial Services, payers, and patients. Works closely with the Revenue Cycle teams and internal departments to resolve issues with insurance companies regarding incorrect registration information, claims processing, contract reimbursement amounts and coding issues.  Demonstrates a thorough understanding of medical office billing-related functions. This role will closely monitor and analyze payor denial trends, perform claim corrections, and perform timely claim follow-up by submitting appeals and claim reconsiderations to ensure maximum payor reimbursement. This role is vital to the overall financial success for the organization.

 
(This is a full time position that will support our team at SouthPark Monday to Friday, 8 am to 5 pm)

• Perform all the responsibilities of the ARS I and ARS II positions.
• Training employees; planning, assigning, and directing work. Perform quality review of team members.
• Employs various modes of communication to train all levels of the organization on systems, programs, procedures, and processes.
• Ensure escalated billing issues are addressed and resolved in a timely manner.
• Acts as a resource and partners with all departments to resolve complex issues related to claims and patient accounts.
• Actively participates in problem identification and resolution, and coordinates resolutions between appropriate parties regarding billing and insurance claims.
• Monitor and assist team members in achieving related metrics goals for key performance indicators.
• Participates and assists in leading cross functional teams to share knowledge and expertise to achieve RCM department goals and initiatives.
• Performs duties and job functions in accordance with the policies and procedures established for the department.
• Meets and exceeds short- and long-term goals as established for the department.
• Recommends new approaches, policies, and procedures to influence continuous improvements in department's efficiency and services performed.
• Work collaboratively with clinic managers and other RCM department staff to improve processes and procedures.
• Participate in department workgroups providing feedback and education on claims activities (payer denials, system issues, etc.).
• Additional duties as assigned.

Requirements:

• Minimum of five (5) years of complex claim follow-up experience in a physician office, hospital, ambulatory surgery center or centralized medical business office.
• Previous experience working with electronic health record (EHR) software. Experience with AthenaHealth EMR is a plus. 
• Thorough knowledge of the entire claims billing process required.
• Knowledge of medical terminology, anatomy, physiology, ICD-10, and CPT codes.
• Knowledge of and experience with billing and collecting from Medicare, Medicaid, commercial, and managed care insurance plans.
• Knowledge of insurance agency operating procedures and practices.
• Ability to communicate effectively with payers, providers, and the clinical operations teams.
• Professional verbal and written communication. Must respect the confidential nature of medical information.
• Capable of following established departmental procedures. Capable of using experience and judgement to plan and accomplish goals.
• Excellent computer skills; Intermediate skills with Microsoft Word, Outlook, and Excel required.
• Advanced knowledge interpreting payor explanation of benefits.
• Excellent verbal communication skills and strong customer-service background.
• Knowledge of HMO/PPO, Medicare, Medicaid, and other payor regulations, payment guidelines, and policies).

• Associate degree in business, healthcare administration or related field. Advanced degree preferred. Five (5) years of revenue cycle experience may be considered in lieu of degree.

Physical Requirements:

• Work consistently requires walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling.
• Must be able to lift and support weight of 35 pounds.
• Ability to concentrate on details.
• Use of computer for long periods of time.

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