Accounts Receivable Specialist - Home Medical Equipment

Responsibilities

• Verify eligibility, obtain benefit quotes, and secure authorizations for services.
• Negotiate reimbursement as appropriate and notify patients of coverage criteria.
• Verify qualifications are met for reimbursement by individual payor guidelines.
• Prepare daily cash deposits for posting, update cash log, verify payment accuracy, post payments, and determine appropriate contractual adjustments, deductibles, and co-pays.
• Research and process refunds, returns, and bad checks.
• Confirm revenue generated accurately.
• Audit charges/claims for qualifications by the appropriate payor's guidelines.
• Submit claims electronically or by paper according to payor's specifications and filing limits.
• Update all HCPC codes, modifiers, and ICD10 codes according to payor's requirements.
• Review and process unpaid claims for assigned accounts.
• Work and track denials and all correspondence from assigned payors.
• Prepare formal appeals according to payor's specifications.
• Monitor appropriate reimbursement based upon contractual agreements and fee schedules.
• Obtain necessary documents from patient's medical records.
• Identify and adjust ineligible revenues, contractuals, and uncollectibles/bad debts.
• Ensure timeliness of payments and minimize the risk of uncollectibles/bad debts based upon industry standards.
• Call and/or mail correspondence, statements, and invoices to customers as necessary to update accounts.
• Maintain patient account notes with all correspondence, calls, or any activity on the account.
• Receive calls and explain coverage criteria and the calculations of the charges.
• Perform month-end close functions including financial, tracking, and productivity reporting.
• Comply with guidelines specific to accounts receivable policy and procedures, regulatory bodies, payor sources, individual company's policy and procedures, and other appropriate sources.
• Maintain knowledge of payor requirements and guidelines.
• Maintain knowledge of products and services available through the department and other associated organizations.
• Protect confidentiality of information and follow guidelines for the release of medical information.

Requirements

• High School Diploma/GED required.
• Computer skills, verbal communication skills, and written communication skills.

Qualifications

• Preferred previous experience in medical, billing, or related fields.
• Preferred knowledge of medical terminology, ICD10 codes, and HCPC codes.

Benefits

• Competitive pay, incentives, and referral bonuses.
• 403(b) with employer contributions (when eligible).
• Medical, dental, vision, and prescription coverage, with HSA/FSA options.
• Life insurance, mental health resources, and discounts.
• Paid time off, parental and FMLA leave, short- and long-term disability, and backup care for children and elders.
• Tuition assistance, professional development, and continuing education support.

Benefits may vary based on the market and employment status.