Accounts Receivable Specialist

Job Purpose: (AR) Specialist

This position serves to drive efficient, compliant, and effective claims and denials processing to optimize reimbursement for the organization.  The responsibilities of this role include denied claims and A/R follow up with various payers including but not limited to the following: Commercial Insurances, Medicare, Medicaid, Uninsured Patients, Workers Compensation and First Aid, Occupation Medicine, and other reimbursement categories.   

Essential Functions/Responsibilities

• Collect delinquent outstanding balances as quickly as possible by applying collection best practices as defined by the Standard Operating Procedures and training protocols and/or as defined by the AR manager

• Primary accountability for specific AR scope/function (for example: Commercial or Uninsured or Worker’s Compensation, etc.)

• Utilize various AR reports to target aged balances for collection in order to meet and maintain performance goals as set by Management.

• Evaluate denials and partial payments to determine if further reimbursement is valid

• Effectively participate during team meeting, payer discussions/meetings and conference calls/meetings as needed

• Research and correct cash application of misapplied funds and payments on patient accounts as necessary

• Identify and request adjustments to insurance and patient accounts as necessary, while following departmental procedures and policies related to overpayments and credits and refunds

• Ability to consistently maintain productivity and quality expectations as defined by management

• Alert management to irregularities, insurance trends and areas of concern with reimbursement

• Ability to maintain confidentiality of all information under HIPPA guidelines and policies and maintain PHI integrity

• Responsible for assisting in any new hire training within the AR Management team

• Responsible for assisting all new Rev Cycle cross-team members in the onboarding and training process to educate new CityMD employees on AR Management

• Assists other departments within the Revenue Cycle department with various tasks/duties as assigned

Qualifications

• High School Diploma, GED or Equivalent Required

• Minimum of 2-4 successful years in a business collection environment preferred

• Prior medical billing and healthcare insurance knowledge

• Intermediate MS Word, Excel, Google (GMAIL, G Drive) necessary

• Solid understanding of state laws and insurance fee schedules and their impacts on billing and collection

• Excellent oral and written communication skills

• Excellent organizational and multitasking skills

• Flexible and approachable to colleagues and inter-departmental stakeholders

• Ability to perform functions at established CityMD RCM Support Center

• Workers Compensation and No Fault prior billing experience a plus

Physical Requirements:

This job may require, from time to time, repetitive tasks.

Direct Reports:

None