Accounts Receivable Specialist (Healthcare)

The AR Specialist II is responsible for billing, re-billing, post-payment/account follow-up, and grievance preparation of assigned. Client Hospital Accounts Receivable. Working at a Client site or in a Centralized location, responsibilities may include account maintenance of specialized or multiple payers including state and federal government programs, managed care, commercial and other insurance groups. The AR Specialist may serve as a liaison to clinical auditors, other team members, hospital staff, government
agencies and health plans to facilitate the appropriate and prompt payment of claims.

Responsibilities:

- Verify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the
insurance carrier/providers
- Update patient demographics/insurance information in appropriate systems
- Research/ Status unpaid or denied claims
- Monitor claims for missing information, authorization, and control numbers (ICN/DCN)
- Research EOBs for payments or adjustments to resolve claim
- Contacts payers via phone or written correspondence to secure payment of claims
- Access client systems for payment, patient, claim and data info
- Follows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems
- Secure needed medical documentation required or requested by third party insurance carriers
- Maintain and respect the confidentiality of patient information in accordance with insurance collection guidelines and
corporate policy and procedure
Utilize provider billing manuals to obtain billing guidelines and requirements
Write appeal letters for technical appeals
Verifies accuracy of underpayments utilizing contracts and claims data
Prepares claims for clinical audit processing in the case of authorization, coding, level of care and/or length of stay
denials
Complete special projects as required.

Qualifications:

2+ years of medical collections/billing experience
Intermediate knowledge of ICD-10, CPT, HCPCS and NCCI
Intermediate knowledge of third-party billing guidelines
Intermediate knowledge of billing claim forms (UB04/1500)
Intermediate knowledge of payor contracts
Working Knowledge of Microsoft Word and Excel
Intermediate working knowledge of health information systems (i.e., EMR, Claim Scrubbers, Patient Accounting
Systems, etc.)

Preferred Skills:

- Working knowledge of one or more of the following Patient accounting systems – EPIC, Cerner, STAR, Meditech, CPSI,
Invision, PBAR, All Scripts, or Paragon
- Working knowledge of DDE Medicare claim system
- Knowledge of government rules and regulations