AR Specialist- Medical Billing

About the role

The Account Receivable Specialist is responsible for submitting claims, appeals of denied claims, and working with commercial insurance carriers to ensure prompt, accurate payment.

Responsibilities

• Daily monitoring of denied claims in assigned billing system and re-processing the claims with correct demographic and coding information to ensure timely filing through the clearinghouse.
• Follow-up on all denied claims to ensure payment from insurance companies.
• Utilize weekly Accounts Receivable work list to identify unpaid claims and follow-up with insurance carriers to re-process or appeal claims.
• Initiate tracers with commercial insurance carriers to locate missing or lost payments.
• Document all communication from insurance companies and patients pertaining to the claim status in billing system for tracking purposes.
• Identify and communicate billing trends, including recurrent denials to the AR Manager, which increase accuracy in the billing process.
• Provide support as needed to all members of the billing and auxiliary departments at Gryphon Healthcare.
• Stay abreast of current issues, trends, and changes in the laws and regulations governing medical billing.
• Demonstrate professional customer service standards when communicating with patients and insurance representatives on the phone or in email correspondence.
• Maintain confidentiality of patient data and medical records in compliance with HIPAA guidelines and regulations.
• Maintain a minimal claim resolution rate of 30–50 claims per day.
• Perform other duties as assigned.

Requirements

• High School Diploma or equivalent required.
• 2 years in medical billing preferred with the following detailed experience:
  • Knowledge of medical/billing collection practices.
  • Knowledge of regulatory and payer requirements for reimbursement and reason(s) for denials by auditors.
  • Knowledge of basic medical coding and third-party operating procedures and practices.
  • EMR, EDI, and Commercial Insurance Company systems.
  • PM Systems such as Collaborate and GoRev, including multiple clearinghouses and payments systems.
  • Out of Network (OON) negotiations, appeals, and reconsiderations.
  • Ability to interpret and clearly explain out-of-pocket expenses, EOBs, and CARC/RARC codes to patients, carriers, and other callers.
• Basic computer literacy includes keyboarding skills, Microsoft system (Outlook, Teams, Excel & Word), and the ability to navigate in a Windows environment.
• Understands basic concepts of Excel spreadsheets for work queue.
• Detail-oriented, strong organizational skills, and the ability to prioritize workload.
• Must demonstrate interpersonal skills with all levels of the billing and management team.
• Excellent oral and technical writing and typing skills.
• Must be able to write and speak effectively in English.

Working Environment

• Onsite role in Gryphon’s Houston corporate office.
• Ability to sit, stand, and use office equipment for extended periods.
• Occasional lifting up to 20 lbs. (files, materials).
• Ability to work in a fast-paced, high-volume, and dynamic environment.
• Able to flex hours as needed to meet needs related to unanticipated volume, changes, and/or problems.