AR Specialist | Medicare

About the role

The AR Specialist | Medicare supports the department in various functions, including supporting accounts receivable processes to drive revenue optimization specific to Medicare accounts. This role is critical in enabling efficient revenue cycle operations through robust AR management. This role involves payment posting, adjustments, AR research, follow-up, reporting, and collaborating on process improvements.

Responsibilities

• Process accounts receivable payments and adjustments
• Research and resolve AR discrepancies promptly
• Follow up on outstanding/aged receivables
• Maintain organized AR documentation
• Identify opportunities to improve AR processes
• Have proven experience with hospital inpatient, outpatient, CAH, Method I & II, RHC, and Provider-based billing and AR follow-up knowledge
• Have a solid understanding of billing regulations related to Medicare and Medicare Advantage
• Function independently to complete timely and thorough follow-up on unresolved hospital and physician claims
• Manage RTP and denied claims, including determining the root cause and providing requested information to health plans to resolve identified issues
• Prepare and submit appeals and reconsiderations to health plans
• Adapt quickly to proprietary tools and technology
• Other duties as assigned

Requirements

• 5 years of hospital and physician claims follow-up and denials management
• 3 years of Medicare billing or Medicare follow-up experience
• Proficiency with hospital EMRs: Cerner, Epic, McKesson, CPSI, Meditech, etc.
• Proficiency with various billing systems: Waystar, SSI, Quadax, Availity, etc.
• Proficiency with Medicare DDE system
• Proficiency in MS Excel and MS Outlook
• Excellent written and oral communication skills
• Excellent organizational, time management, and interpersonal skills

Skills

• Proven experience with hospital inpatient, outpatient, CAH, Method I & II, RHC, and Provider-based billing and AR follow-up knowledge
• Solid understanding of billing regulations related to Medicare and Medicare Advantage
• Ability to function independently to complete timely and thorough follow-up on unresolved hospital and physician claims
• Strong proficiency in managing RTP and denied claims, including the ability to determine the root cause, and providing requested information to health plans to resolve identified issues
• Strong proficiency in preparing and submitting appeals and reconsiderations to health plans
• Quick adaptation to proprietary tools and technology