Accounts Receivable Claims Specialist

A/R Claims Specialist for Reputable Healthcare Organization!!

This Jobot Job is hosted by: Kristin Ursua
Are you a fit? Easy Apply now by clicking the “Apply Now” button and sending us your resume.
Salary: $21 – $25 per hour

A bit about us:

We are a Nationwide Healthcare Organization assisting people with their healthcare needs for many years. We truly care about everyone who who we help and do all that we can to assist them with their health issues, questions or concerns. We have medical and non-medical partners, which operate numerous healthcare facilities across the U.S. We also partner with organizations, globally. The company provides a variety of health services, as well as continually researching health technology to better their practices.

Why join us?

CORE COMPETENCIES – WE CARE:

• Welcoming: Anticipates customer requirements and gives high priority to customer satisfaction and service. Handles problems quickly and efficiently. Maintains a pleasant,

positive and professional approach. Embraces opportunities to help team members, stakeholders, and other departments.

• Ethical: Deals with others in a sincere and honest manner. Accepts responsibility for actions. Supports company values and follows the Standards of Conduct.
• Confidential: Respects the information shared by our patients, employees, and vendors and maintains appropriate confidentiality. Follows all policies and laws that protect private

& privileged information.

• Accessible: Is available and approachable to others, open-minded, fair and non-defensive. Appreciates constructive feedback and is a team player. Demonstrates good listening

skills.

• Respectful: Values diversity and treats everyone with dignity and courtesy. Dependable and courteous of other people’s time and commitments.
• Empathetic: Demonstrates interest and understanding in other people’s feelings, attitudes and reasoning. Maintains an open and non-judgmental demeanor that is patient,

flexible, and understanding.

Job Details

GENERAL DESCRIPTION:

The Accounts Receivable Claims Specialist assures timely reimbursement of clean claims, corrects denied claims, and appeals denied or delayed claims with specific payors in order to receive reimbursement for healthcare claims. Responsible for aging management and efficient claims collections and (1st Level) follow up.

JOB REQUIREMENTS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum Education:

• High School Diploma or equivalent required.

Minimum Work Experience:

• A minimum of 2-4 years of experience as a medical biller/claims follow-up specialist or collections specialist in an outpatient medical setting (non-hospital) in primary care (required), family planning, ob-gyn, and related surgeries required.
• Knowledge of medical terminology and common industry abbreviations required.
• 2-4 years of experience in billing and coding procedures required.
• 2-4 years of experience with insurance billing and reimbursement procedures required.
• A minimum of 2 years of experience with HIPAA 5010 transaction standards required.
• A minimum of 2 years of claims follow-up/appeals and health plan Accounts Receivable management for specific payors required.

Other Requirements:

• Ability to successfully communicate with payors including insurance companies, health plans, and medical groups regarding unpaid claims.
• Knowledge of Medi-Cal Managed Care, Commercial Payors, Medi-Cal, FPACT, & PE.
• Knowledge of health care and Medi-Cal denial reasons, denials codes and descriptions and standard denial resolution practices.
• Strong verbal and written communication skills are essential.
• Ability to demonstrate mature judgment, initiative and critical thinking.
• Strong follow-up skills and time management with internal and customer stakeholders
• Ability to maintain confidentiality.
• Accuracy and attention to detail is essential.
• Professional demeanor at all times.
• Ability to work flexible hours including weekends.

Agency Standard Requirements:

• Strong commitment to quality healthcare and excellent customer service is required.
• Must thrive in a fast paced, rigorous environment with changing priorities.
• Ability to meet deadlines and work under pressure
• Must demonstrate high level computer skills including; Microsoft Word, Excel and Outlook. Electronic medical records experience may also be required.

JOB DUTIES AND RESPONSIBILITIES:

Essential Functions: Essential functions encompass the required tasks, duties and responsibilities performed as part of the job and the reason the job exists.

• Knowledge of payor guidelines.
• Knowledge of industry standard and Medi-Cal denials reasons/codes.
• Compiles billing, and payor documentation to create training documents.
• Ensures healthcare facilities are reimbursed at the correct rate for all procedures.
• Processes payments from insurance companies.
• Follows up on claim submissions to determine batch acceptance, rejection, or denial in a timely manner.
• Researches, corrects, resolves, resubmits and appeals denied claims/services.
• Corresponds with insurance companies to resolve the issue; submits appeals per payor requirements.
• Maintains collections rate for assigned payors at or above 70% of allowed charges.
• Maintains A/R percentage of 20% for A/R less than 90 days.
• Communicates with RCM leadership about payor updates, changes, and requirements.
• Reviews delinquent accounts and calls responsible party(ies) for collection purposes.
• Sorts and files paperwork from health plans, patient charts, and payment correspondence.
• Updates Division of Financial Risk (DOFR) quarterly with staff and report issues to supervisor.
• Supports team in their efforts to provide payors with information or documentation necessary for payment of claims and/or any other account follow up required to recover payment within a required timeframe.
• Reviews underpayments and overpayment trends and report to supervisor.
• Maintains refund log and enters refunds in system.
• Investigates insurance fraud and reports immediately if found.
• Maintains strict confidentiality at all times.
• Ensures timely filing of insurance claims
• Assists with processing incoming mail including payments and EOB statements.
• Prepares adjustments for patient accounts.
• Follows up on unpaid or underpaid claim charges (1st Level).
• Maintains a log of open issues with dates for follow ups.
• Performs 1st level collections on accounts with overdue balances.
• Responds to payor requests for information in a timely manner.
• Participates in payor meetings as needed.
• Manages AR reports to quantify, track and trend payor issues.
• Submits 1st level appeals.

Interested in hearing more? Easy Apply now by clicking the “Apply Now” button.