A/R Specialist – Patient Account Services
JOB PURPOSE: Position is responsible for researching and resolving outstanding claims issues to ensure maximization of claims reimbursement.
JOB QUALIFICATION REQUIREMENTS:
• High school education or equivalent, with specialized training.
• Two years experience of Medical Insurance Collections/Follow up
• Two years experience using a computerized accounts receivable system in a medical or hospital environment performing billing functions.
• Knowledge of current ICD-9 coding in a medical or hospital setting.
• Experience handling confidential data i.e., patient demographic information, payor fee schedules, reimbursement rates, etc.
• Knowledge of current CPT-4 and ICD-9 coding.
• Knowledge of common insurance plans, i.e., HMO, PPO, Capitation, Medicare and Medi-cal
• Proficient skills in computer programs.
• Ability to understand and interpret policies and procedures.
• Ability to communicate effectively and work with others.
• Ability to apply principles of analytical thinking to extract correct data from documentation.
Equipment Operated: Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.
Work Environment: Position is in a well-lighted office environment.
Physical Requirements: Involves sitting approximately 90 percent of the day, walking or standing the remainder.
• Monitor all payer types on unresolved claims by running appropriate reports and contacting insurance companies to resolve claims that are not paid in a timely manner
• Identify coding or billing problems from EOBs and work to correct the errors in a timely manner
• Identify problem accounts and escalate as appropriate
• Identify trends and make suggestions on process improvements
• Update the patient account record to identify actions taken on the account
• Work with patients and guarantors to secure payment on outstanding account balances
• Sort and file correspondence
• Initiate appeals for denied claims as appropriate
• Enter detailed notes to provide an audit trail for future follow up
• Work error reports in a timely manner (set by Director/Manager)
• Meet with assigned Providers as needed
• Meet with insurance carriers as issues are identified