Specialist-Accounts Receivable Follow Up

Responsibilities

• Performs online account status checks and contacts payers to follow up on outstanding claim balances of assigned accounts in work queues.
• Clearly documents in EMR system the patient account notes, the payment status of the account, and/or actions taken to secure payment.
• If applicable, requests account for additional follow up activity within a prescribed number of days in accordance with payer specific filing requirements or processing time required for insurance to complete processing.
• Performs required actions to resolve the account balance promptly by submitting appeals, correcting account information, coordinating requests for medical records, requesting and/or performing posting of account adjustments, requesting an account rebill and any and all other actions necessary to secure account payment and/or bring the account to successful closure.
• Documents, tracks, and ensures a reasonable turnaround time of receipt of any outstanding documents required from external departments.
• Responds to claim denials from payers such as inability to identify the patient, coordination of benefits, non-covered services, past timely filing deadlines, and ensures all information is provided to the payer.
• Documents all actions taken on accounts in the EMR system account notes to ensure all prior actions are noted and understandable.
• Informs the supervisor of any problems or changes in payer requirements and exercises independent judgment to analyze and report repetitive denials to take appropriate corrective action.

Requirements

• Achieves established productivity and quality standard as determined by the Baptist Productivity and Quality Expectations.
• Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact patient account collections.
• Adheres to internal controls for applicable state/federal laws, and the program requirements of accreditation agencies and federal, state and private health plans.
• Sets seeks advice and guidance as necessary to ensure proper understanding.
• Effectively utilizes payer websites as needed in the execution of daily tasks.
• Conducts account claim status and follow up and resolves claim payment denials.
• Makes sure assigned work queues at all sources are resolved expeditiously while working with other departmental representatives in resolution.
• Reports unresolved issues and concerns impeding the collection process and to ensure successful account resolution.
• Complies with patient confidentiality policies for the retention of patient health information, or when handling, distributing, or disposing of patient health information.

Qualifications

• Minimum Required Experience in the healthcare setting or educational coursework.
• One (1) year experience in physician’s office or hospital setting.
• Preferred/Desired Knowledge of insurance billing and collections and insurance guidelines.
• Knowledge of ICD-9, ICD-10, CPT and HCPCS codes and certification and/or degree in Healthcare Administration Business, Finance or related fields preferred.
• Able to recognize and communicate to clinical staff or designee when insurance companies require additional review because of NCCI, CCI , LMRP, Mutually Exclusive and Medical Necessity edits.
• Effective Verbal, written and customer service skills as it relates to patients and insurance companies.
• Able to create communications to patients and insurance companies as needed to resolve issues to complete billing/claim processes.