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Accounts Receivable Specialist

Job Posted 1/25/2025
EmergeOrtho
Durham, NC 27704
United States
Category Accounting
Job Description
Description

Remote/Work from Home

Work Hours: Monday - Friday, 8AM - 5PM

The Accounts Receivable Specialist ensures financial integrity and accounts receivable by performing established financial processes that expedite medical services' billing and collection. This includes creating claims according to regulations and compliance guidelines, patient account research and resolution, insurance verification and benefit determinations, identification of reimbursement issues, resolution of credits and issuance of refunds, identification of payment variance invoices, follow-up, and resolution of denied claims. Responsible for working correspondence denials and insurance follow-up. This must be done in a timely and accurate manner, in accordance with the provided work instructions by performing the following duties.

Requirements

Qualifications and Experience
  • High school diploma or equivalent
  • Minimum three years' experience in healthcare or medical practice setting
  • Working knowledge of insurance and managed care industry requirements
  • Medical terminology, ICD-10 and HIPAA

Responsibilities include, but are not limited to the following
  • Monitor and execute work against the assigned team-associated Custom Claim Worklist(s), relational AR Worklist(s), reporting, projects, or team/department goals
  • Oversight of HOLD Worklists
  • Research and resolution of claims based on assignment, the process of which could include:
    • Contacting payers via phone or website, contacting practices, navigating cross-departmentally, writing appeals, and facilitating their direction to Athena CBO for submission, and all other activities that lead to the successful adjudication of eligible claims
  • Coding and charge entry based assigned work and associated responsibilities (Specialty, CPC)
  • Responsible for assigned AR including all Holds, Mgr. Holds, and outstanding AR requiring follow-up
  • Run reports for analysis, trending, subdivision of work, or distribution based on direction (both self and managerial) as needed to communicate with all internal stakeholders
  • Manage and resolve Zero-Pay Worklist, Fully Worked Receivables, complete special project work, review and respond to adjustments/payment data with approval (or initiate appeal) communicate trends and root issues through proper lines of reporting
  • Receive calls or emails from Patient Financial Services Specialists with patient's requesting advanced assistance with their account
  • Illustrate excellent knowledge of healthcare industry regarding the revenue cycle, coding, claims, and state insurance laws
  • Create patient cases to the correct clinical contact for additional information or corrections to be made with the appropriate details of what is needed
  • Meet productivity standards as set by management
  • Keep management informed of correspondence and communication problems with service locations
  • Maintain knowledge and understanding of insurance billing procedures to understand the reason for claims in HOLD, MGRHOLD, and OVERPAID status to ensure resolution and timely payment
  • Educate and communicate revenue cycle/financial information to patients, payers, coworkers, managers, and others as necessary to ensure accurate processes
  • Performs other duties as required and assigned by Manager