Accounts Receivable Specialist LOA

Job Description

Job Description

Description:

Under the direction of the Revenue Cycle Director, the Accounts Receivable Specialist LOA is responsible for the accurate management, follow-up, reconciliation, and resolution of self-pay and patient-responsibility accounts receivable. Ensures patient balances are accurate, payments are properly applied, appropriate coverage and sliding fee eligibility have been considered, and accounts are worked timely and consistently in accordance with Zufall Health policies and applicable regulatory requirements.

Essential Functions, Duties and Responsibilities

• Reviews and works self-pay and patient-responsibility accounts receivable, including aging balances, to support timely and accurate account resolution.
• Reviews patient accounts for accuracy of charges, payments, adjustments, insurance coverage, and patient responsibility before initiating collection activity.
• Validates and confirms patient payments and researches unapplied, unposted, or misapplied payments; coordinates corrections as necessary.
• Reviews accounts identified as self-pay to determine whether active insurance, Medicaid, Medicare, commercial coverage, or other third-party coverage may be available and refers discrepancies for correction.
• Reviews patient accounts for appropriate application of the Sliding Fee Discount Program and approved discounts or adjustments in accordance with Zufall Health policy.
• Assists with the patient statement process by reviewing balances for accuracy, researching statement questions, and resolving account discrepancies.
• Communicates with patients regarding account balances, statements, payment history, payment arrangements, and other patient financial questions in a professional and respectful manner.
• Coordinates with Patient Representatives, registration staff, billing staff, and other departments to resolve eligibility, demographic, payment, and account-balance issues affecting self-pay receivables.
• Reviews self-pay aging reports and prioritizes follow-up based on account age, balance, and established Revenue Cycle procedures.
• Reviews accounts for possible bad debt or collection agency assignment and makes recommendations to the Revenue Cycle Manager in accordance with Zufall Health policy.
• Identifies credit balances and potential patient refunds and prepares or routes accounts for appropriate review and resolution.
• Performs account reconciliation and assists in reconciling self-pay A/R reports, patient payment activity, and related system reports; researches and escalates discrepancies.
• Maintains documentation of account follow-up activity and ensures notes are complete, accurate, and sufficient to support actions taken.
• Identifies recurring trends affecting self-pay A/R, including registration errors, incorrect payer classification, payment posting issues, or workflow gaps, and communicates findings to the Revenue Cycle Manager.
• Responds to questions from patients, clerical staff, and other Zufall Health personnel regarding self-pay balances and patient account activity.
• Meets established productivity, quality, and follow-up expectations for assigned self-pay accounts and provides reports or status updates as requested.
• Conducts self in accordance with Zufall Health's employee handbook, policies, procedures, and standards of conduct.
• Maintains the strictest confidentiality and adheres to all HIPAA guidelines and regulations.
• Performs other duties as determined by the Revenue Cycle Manager or Director of Billing.

Requirements:

• Prior experience in medical billing, patient accounts, accounts receivable, collections, or healthcare revenue cycle preferred.
• Knowledge of self-pay accounts receivable, patient statements, payment posting, account reconciliation, and healthcare billing processes preferred.
• Knowledge of Medicaid, Medicare, commercial insurance, uninsured patient workflows, and sliding fee discount programs preferred.
• Knowledge of computer programs and electronic practice management or billing systems.
• Ability to operate a computer and basic office equipment and to learn new systems and workflows.
• Strong analytical and problem-solving skills with the ability to research account discrepancies and determine appropriate next steps.
• Ability to communicate with patients by telephone or other approved methods in a pleasant, professional, and helpful manner, including conversations regarding patient financial responsibility.
• Ability to read, understand, and follow oral and written instructions, policies, procedures, and billing guidelines.
• Ability to establish and maintain effective working relationships with patients, employees, and the public.
• Must be well organized, detail-oriented, accurate, and able to manage multiple priorities and follow-up deadlines.
• Ability to maintain confidentiality and exercise sound judgment when handling sensitive patient and financial information.

Education, Training and Experience

• High School Diploma or GED required.
• Additional education or training in medical billing, healthcare administration, or a related field preferred.