Specialist-Accounts Receivable Follow Up Senior

Responsibilities

• Performs online account status checks and contacting 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.
• Achieves established productivity and quality standard as determined by the Baptist Productivity and Quality Expectations.

Requirements

• 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 and adheres to established productivity and quality standards.

Qualifications

• Minimum Required Experience in the healthcare setting or educational coursework.
• Two (2) 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.
• Ability to type and key accurately, problem solving, written an d oral communication skills, financial counseling skills - knowledge of insurance billing (both hospital and professional settings) and collections - knowledge of insurance guidelines as it relates to CMS guidelines, TennCare and/or Medicaid based by state specified requirements.
• Able to create communications to patients and insurance companies as needed to resolve issues to complete billing/claim processes.