AR Collections Specialist

Sevita is a mission-based organization dedicated to providing high-quality services to those we serve. Every employee is expected to perform their job in alignment with the Company’s mission.

About the role

The AR Collections Specialist is responsible for timely follow-up on claims that have been paid incorrectly or remain unpaid. They communicate with field teams and supervisors about issues preventing claims from being sent to payers and ensure claims are submitted accurately and promptly.

Responsibilities

• Updates collection procedures as necessary
• Reviews and works denials in workflow system daily
• Reviews and works denials in payer portal and/or clearinghouse portal daily
• Reviews and works tasks in denial workflow system for follow-up dates set to expire on that day
• Reviews and works tasks in denial workflow system for claims without a payer response after 30 days from billing
• Follows up with Field on updates to items assigned to them that are past the follow-up date
• Updates denial workflow system with clear, concise notes as claims are worked
• Notifies Field of denials that require their attention
• Notifies biller when claims can be electronically rebilled
• Sends out paper or completes web portal billing once corrections are made
• Communicates with Field Finance and SSC Management on collections issues
• Reviews unapplied cash log for items that can be applied and works with the cash team to resolve
• Works credit balances on the aging and overpayment account, following credit balance procedures for resolution
• Prepares appeal packets as required by payers, scans and saves documentation, updates denial workflow system, and has Supervisor review prior to sending
• Follows up on appeal status with payer after 30 days and bi-weekly thereafter until paid
• Completes necessary forms and provides support for refunds, cash moves, sales adjustments, and transfer of liability
• Ensures internal control compliance and meets audit requirements for assigned areas
• Assists in onboarding new hires by providing required training
• Actively participates in team meetings and fosters collaboration
• Proactively supports management and departmental goals
• Supports special projects and mission-critical initiatives
• Ensures Sarbanes-Oxley compliance for assigned areas, including oversight of control design and remediation
• Performs system testing and other related duties as required

Requirements

• High school diploma or equivalent (Associates or Bachelor’s degree in a Finance-related field preferred)
• Two to three years of experience with Medical Collections in a high-volume environment preferred
• Knowledge of ICD-10 diagnosis codes and CPT medical service codes
• Knowledge of UB-04 and HCFA-1500 forms
• Strong understanding of medical collections compliance
• Strong understanding of Medicare, Medicaid, Medicaid managed care, Commercial, Workers Comp, and Auto-no-fault payer types
• Self-motivated and detail-oriented
• Excellent communication skills
• Highly organized with the ability to multi-task
• Analytical skills with the ability to collect information from different sources
• Proficiency in Microsoft Office (Word, Excel, PowerPoint, Outlook, etc.)

Other Requirements

This position is primarily remote but requires occasional in-person meetings and related travel. Due to business and employment requirements, we are unable to employ individuals in this role who will be working from Alaska, Hawaii, New York, Oregon, South Dakota, Vermont, Washington State, or Washington, D.C.

Physical Requirements

Sedentary work. Exerting up to 10 pounds of force occasionally and/or negligible force frequently to lift, carry, push, pull, or move objects. Involves sitting most of the time, with occasional walking and standing.