ACCOUNTS RECEIVABLE SPECIALIST

Overview:

The responsibilities of an Accounts Receivable Specialist is to pursue reimbursement of services rendered and achieve accounts receivable resolution. specific tasks include resolving insurance carrier denials, appealing claims, contacting carriers on open accounts and responding to insurance carrier correspondence and/or inquiries.

Essential Duties

• Consistently meet or exceed current productivity and quality standards in a timely resolution of all claim edits, reporting of candidates for bill, outbound complaint claim submission, clinical documentation requirements and any other communication required (verbal or written) regarding claims ensuring timely filing of claims and clean, complete and accurate claims
• Timely follow-up on denials and appeals, including root cause analysis to reduce/prevent future denials while working to overturn denials for payment resolution.
• Compliant follow-up correspondence to third party payers regarding outstanding accounts receivables (i.e., Statements, letters, emails, faxes, portal mail, etc.).
• Understanding of payer types (i.e., Managed Care, Commercial, Medicare, Medicaid, Replacement plans, Workers' Compensation, Corporate Accounts, Research, and Specialty AR Accounts).
• Understanding of payer Medical Reimbursement policies.
• Update registration information, post denial codes and adjustments in practice management systems.
• Recommend accounts for contractual or administrative write-off and provide appropriate justification and documentation.
• Practice HIPAA privacy standards and ensure compliance with patient health information privacy practices.
• Identify opportunities for customer, system and process improvements and submit to management.
• Follow the Riverside Healthcare general policies and procedures, the department policies and procedures and any emergency preparedness procedures.
• Assist with special projects and other duties as assigned, as necessary.

Responsibilities:
Required Experience

• At least 2 years of related work experience
• Detail oriented, good organizational skills, and ability to be self-directed.
• Working knowledge of physician billing and follow up, including an understanding of insurance rules and regulations.
• Knowledge of HIPAA standards.
• Ability to perform mathematical calculations.
• Excellent communication skills when dealing with patients, families, public, co-workers, and professional offices.
• Basic knowledge of medical terminology and billing practices.
• Extensive experience and knowledge of PC applications, including Microsoft Office and Excel.

Preferred Experience

• Knowledge of Epic systems.
• Three or more years of progressive work experience in a hospital/physician billing or SBO

Required Licensure/Education

• High school graduate or equivalent

Preferred Education

• Two years of college or college degree
• Physician coding certification (CPC through AAPC or CCA through AHIMA) preferred

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our Commitment to You:

Riverside Healthcare offers a comprehensive suite of Total Rewards: benefits and nationally rated employee well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more so your journey at and away from work is remarkable. Our Total Rewards package includes:

Compensation

• Base compensation within the positions pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift differential, on-call
• Opportunity for annual increases based on performance

Benefits - .5 to 1.0 FTE

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Health Savings and Flexible Spending Accounts for eligible health care and dependent care expenses
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

Benefits - .001 to .49 FTE:

• Paid Leave Hours accrued as you work

Employee Health Requirements

Exposure to:

• Chemicals: None
• Video Display Terminals: Average
• Blood and Body Fluids: Performing ER and Admitting registrations have the potential to be exposed.
• TB or Airborne Pathogens: Performing ER and Admitting registrations have the potential to be exposed.

Sensory requirements (speech, vision, smell, hearing, touch):

• Speech: Required to communicate during presentations/training, telephone communication, and facilitate meetings.
• Vision: Needed to read memos and literature, close vision (ability to adjust focus).
• Smell: NA
• Hearing: Needed for telephone communication, meetings, alarms and listening to employee concerns.
• Touch: Needed to write, computer entry, filing.

Activity/Lifting Requirements:

Percentage of time during the normal workday the employee is required to:

• Sit: 50-88%
• Twist: 5%
• Stand: 1%
• Crawl: 0%
• Walk: 12-50%
• Kneel: 0%
• Lift: 0%
• Drive: 0%
• Squat: 0%
• Climb: 0%
• Bend: 5%
• Reach above shoulders: 2%

The weight required to be lifted each normal workday according to the continuum described below:

• Up to 10 lbs: Frequently
• Up to 20 lbs: Frequently
• Up to 35 lbs: Occasionally
• Up to 50 lbs: Occasionally
• Up to 75 lbs: Not Required
• Up to 100 lbs: Not Required
• Over 100 lbs: Not Required

Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.):

Carrying materials such as charts and labels waist high and for approximately 20 feet.

Maximum consecutive time (minutes) during the normal workday for each activity:

• Sit: 30
• Twist: 1
• Stand: 5
• Crawl: 0
• Walk: 5
• Kneel: 0
• Lift: 0
• Drive: 0
• Squat: 0
• Climb: 0
• Bend: 0
• Reach above shoulders: 1

Repetitive use of hands (Frequency indicated):

• Simple grasp up to 10 lbs. Normal weight: 5-10lbs frequent
• Pushing \& pulling Normal weight: Up to 50lbs
• Fine Manipulation: Computer keyboard, writing, calculator.

Repetitive use of foot or feet in operating machine control: Not Required

Environmental Factors \& Special Hazards:

• Environmental Factors (Time Spent):
• Inside hours: 8
• Outside hours : 0
• Temperature: Normal Range
• Lighting: Average
• Noise levels: Average
• Humidity: Normal Range
• Atmosphere: Normal Range

Special Hazards: None

Protective Clothing Required: None

Pay Range: USD $24.36 - USD $30.09 /Hr