Accounts Receivable Specialist

Accounts Receivable Specialist

The Accounts Receivable Specialist performs resolution oriented activities with a focus on comprehensive medical billing, payment posting, and/or collection actions. While ensuring compliance with relevant laws, regulations and established company policies and compliance programs this role is responsible for efficient cash collections through excellent reimbursement practices, accurately posting of EFT, credit card, ACH and check insurance/patient payments, and/or performing accurate claim billing.

Essential Duties and Responsibilities

The essential functions may include, but are not limited to the following:

• Supports and/or performs daily duties as assigned in one or multiple areas of the department which include:
• Payment Posting: EFT, credit card, ACH, live check and insurance payments
• Researches and evaluates insurance payments and correspondence for accuracy
• Accurate processing and posting of insurance and patient payments
• Matches EOB and payment records with payments
• Processing write offs according to company policy
• Batching and scanning of payments to ensure records are on file
• May assist with administrative duties fundamental to successful posting or project operations
• Billing: Accurate and timely submission of all claims for all payers
• Daily claim/invoice submission for primary, secondary and tertiary payers and/or patient statements
• Review rejected claims, perform correction activities and ensure resubmission as appropriate
• Ensure all Contract Billing Partner billing is submitted to appropriate outsourced partner
• Collections: Timely and accurate follow up on unpaid claims or patient accounts
• Work assigned lists of outstanding claim balances and/or patient accounts with multifaceted issues across different payers and patients
• Identify trends, conduct follow up and perform root cause analysis on unpaid and underpaid insurance claims across different payers
• Analyze and resolve billing discrepancies on patient accounts. Ability to explain findings to patient
• Use persuasive written and oral communication skills to draft appeals and effectively overturn denied or underpaid claims
• Perform actions towards remediation of outstanding balances according to policy and procedure; including but not limited to, in depth research appeals, rebilling, calling the payer or clinic, and utilizing payer portals
• Identify and communicate issues or trends to department management ensuring consistent and efficient department process
• Ensure adherence with federal regulatory timeframes for handling cases including acknowledging cases, resolving cases, monitoring effectuation of resolution, completing resolution letters and communicating with members and providers within required time frames
• Work collaboratively within the team and with other departments
• Be a positive role model willing to share knowledge, skills and expertise with all members of the team
• Comply with all HIPAA and privacy regulations
• Adhere to laws and best practices in regards to dealing with patients and patient data
• Perform other job-related duties as assigned

Minimum Qualifications (Knowledge, Skills, and Abilities)

• High School Diploma or GED required, college degree preferred
• Experience with claim submission, payment posting, appeal and denial processes; minimum 1 year required
• Experience in medical device billing and/or general healthcare reimbursement, minimum 1 year required
• Understanding of healthcare methodologies (coding, coverage, criteria, payments)
• Able to work collaboratively and cross-functionally with other departments to facilitate appropriate resolutions
• Excellent problem solving and analytical skills, required
• Ability to prioritize work and analyze workflow deficiencies to improve processes
• Ability to consistently meet appeals accuracy and timeline requirements by achieving regulatory standards
• Must have good computer skills, experience with Microsoft Office, required
• Able to communicate clearly, both orally and in writing
• Able to work effectively with a wide range of people
• Time management skills
• Excellent organizational skills and attention to detail

Physical Demands and Work Environment

• Must be able to work onsite at our corporate headquarters in Maryland Heights, MO
• Must be able to work in an office setting, use a computer, keyboard and mouse for the majority of the shift and be able to communicate on the telephone
• Must be able to work the scheduled 8 hour shift Monday-Friday