Accounts Receivable Specialist II

Responsibilities

• Verifies or obtains patient eligibility and/or authorization for healthcare services performed.
• Updates patient demographics and/or insurance information in appropriate systems.
• Counsels research and appropriately statuses unpaid or denied claims.
• Makes sure claims are complete with missing information, authorization and control numbers (ICN//DCN).
• Researches EOBs for payments or adjustments to resolve claims.
• Contacts payers by phone or through written correspondence to secure payment of claims.
• Acesses client systems for information regarding received payments, open claims and other data necessary to resolve claims.
• Accesses medical documentation as required or requested by third party insurance carriers.
• Obtains billing guidelines and requirements by researching provider billing manuals.
• Writes appeal letters for technical appeals.
• Verifies accuracy of underpayments by researching contracts and claims data.
• In the event of an authorization, coding, level of care and/or length of stay denial, prepares claims for clinical audit processing.

Requirements

• High school diploma or GED.
• At least two years of experience in healthcare insurance accounts receivable follow up, working with or for a hospital/hospital system, working directly with government or commercial insurance payers.
• Experience identifying billing errors and resubmitting claims as well as following up on payment errors, low reimbursement and denials.
• Experience reviewing EOB and UB-04 forms to conduct A/R activities.
• Knowledge of accounts receivable practices, medical business office procedures, coordination of benefit rules and denial overturns and third-party payer billing and reimbursement procedures and practices and practices.
• At least two years of experience with accounts receivable software.
• Experience navigating payer sites for appeals/reconsiderations, benefits verification and online claims follow up.
• Demonstrated ability to navigate Internet Explorer and Microsoft Office, including the ability to input and sort data in Microsoft Excel and use company email and calendar tools.
• Demonstrated success working both individually and in a team environment.
• Demonstrated experience communicating effectively with payers, understanding complex information and accurately documenting the encounter.
• Ability to work effectively with cross-functional teams to achieve goals.
• Demonstrated ability to meet performance objectives.