AR Rep Customer Service T2

About the role

This position is responsible for handling Customer Service phone calls, legal release of information, initial billing, re-billing, and account follow-up and/or grievance preparation for assigned Client EMR Accounts Receivable. Responsibilities may include account maintenance for specialized or multiple payers, including state and federal government programs, managed care, commercial, and other insurance groups. The role involves partnering with other team members and health plans to facilitate prompt payment of claims while demonstrating a commitment to the organization’s strategic plans, goals, and values.

Responsibilities

• Accepts and resolves incoming patient billing inquiries.
• Handles legal billing release of information documentation.
• Performs initial billing and follow-up for workman’s compensation, IBCCP, and liability claims.
• Reviews and/or scrubs final billed initial claims for accuracy and completeness prior to submission.
• Submits electronic and/or hardcopy claims with attachments per contract timely filing criteria.
• Documents all account activity in the hospital/client system and The Q with clear and concise notes.
• Contacts health plans by phone or website to determine claim status within appropriate time frames.
• Documents all follow-up actions and sets up accounts for additional review based on client expectations.
• Researches and validates paid or partially paid claim status in accordance with client contract agreements.
• Reviews denied, dis-allowed, or non-covered claims/charges and determines accuracy based on contract language.
• Resolves technical issues with payers when warranted.
• Follows client-specific procedures to request adjustments and refunds.
• Prepares appeals and necessary documentation for authorization, coding, level of care, and/or length of stay denials.
• Adheres to guidelines for prioritization and timely filing deadlines.

Work Environment

• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift 15 pounds at one time.
• Must structure your home office to ensure patient information is secure and meets regulatory expectations.

Requirements

• High School diploma or equivalent.
• 2+ years of previous experience in healthcare revenue cycle management.
• Ability to work independently and within a team atmosphere.
• Self-motivated and passionate about the mission and values of quality work.
• Proficient in business/office standard processes and technical applications.

Skills

• Maintains compliance with regulations and laws applicable to the job.
• Professional level of communication via video, phone, and email.
• Ability to effectively prioritize work to meet deadlines and expectations.
• Meets quality and productivity measures as outlined by Quadris.
• Brings positive energy to work.
• Uses critical thinking skills.
• Stays present and focused on assigned tasks while eliminating distractions.
• Demonstrates self-starter capabilities.