Hybrid Accounts Receivable Specialist Accounts Receivable Specialist

DescriptionAccounts Receivable Specialist (Biologic/Immunotherapy)Job SummaryA/R Revenue Cycle Specialist is responsible for the basic collection of unpaid third-party claims and standard appeals. This role’s primary function is to communicate with payers to resolve issues and facilitate prompt payment of claims. Follow-up with insurance companies to collect outstanding accounts for which payment are not received in response to the claim's submission process, either electronically or by paper. Recognize and resolve incorrect demographic and insurance registration based on an understanding of the outpatient registration process. The Specialist will use an understanding of claims submission requirements for payors to expedite payments and possess a knowledge of appeals and rejections processes to resolve standard issues or escalate to a more senior specialist.Required Education/Experience

• High School Diploma
• Minimum 2 years’ experience in a healthcare setting
• Proficient with Microsoft applications
• Knowledge of various payer processing and submission guidelines.
• Familiarity with compliance of HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI).
• Working knowledge of medical billing applications.
• Utilize online resources to facilitate efficient claims processing.
• Knowledge of medical terminology, CPT codes and diagnosis coding.
• Excellent interpersonal, communication and customer service skills required.

Essential Functions

• Uses A/R follow-up systems and reports to identify unpaid claims for collection/appeal.
• Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract.
• Review and update patient registration information (demographic and insurance) as needed.
• Prepares delinquent accounts for transfer to self-pay collection unit according to the follow-up matrix.
• Retrieves supporting documents (medical reports, authorizations, etc.) as needed and submits to third-party payers.
• Appeals rejected claims and claims with low reimbursement.
• Confirm credit balances and gather necessary documentation for processing refund.
• Identifies insurance issues of primary vs. secondary insurance, coordination of benefits eligibility and any other issue causing non-payment of claims.
• Contacts the payors or patient as appropriate for corrective action to resolve the issue and receive payment of claims.
• Identifies and escalates non-standard appeals to a higher-level specialist.

POSITION RELATIONSHIPS

• Reports directly to the Billing Manager
• Subject to a 90-day probationary period

RequirementsEEOC ComplianceFamily Allergy & Asthma provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.Please Complete Survey to be Considered: https://surveys.cultureindex.com/s/kgvM7SYDhF/102127