The Accounts Receivable Specialist I is responsible for follow-up work to collect on all open and unpaid accounts with insurance companies and third parties. Responsibilities include inquiring about unpaid claims, appealing denied claims with insurance companies, and contacting patients or account guarantor.
Through an assigned work queues, the Accounts Receivable Specialist I will follow protocols to determine best course of action to follow up on open receivables.
Applies strong working knowledge of all aspects of billing and collections including billing policies, regulations, diagnosis and procedure coding, and applicable to determine resolution.
Researches root issue of denial. Apply knowledge of payer policies to pursue proper course of appeal or follow up to obtain payment.
Reviews account history for continuous follow up.
Addresses incoming correspondence and respond timely to ensure prompt resolution. Prepares correspondence to insurance companies, patient and/or guarantor, as necessary.
Contacts insurance companies and/or patient/guarantor through phone contact, correspondence, online portals and other approved means to obtain status of outstanding claims and submitted appeals.
Documents clearly in billing system the claim issue and course of action taken on every account worked. Documentation and action must be clearly noted for future follow up and review.
Performs charge corrections based on payer and institutional policies.
High school graduate or GED certificate is required.
A minimum of 6 months’ experience in a physician billing or third party payor environment.
Candidate must demonstrate a strong customer service and patient focused orientation and the ability to understand and communicate insurance benefits explanations, exclusions, denials, and the payer adjudication process.
Must demonstrate effective communication skills both verbally and written.
Ability to multi-task, prioritize, and manage time effectively.
Functional proficiency in computer software skills (e.g. Microsoft Word, Excel and Outlook, E-mail, etc.)
Ability to work independently and be a team player.
The ideal candidate is a motivated individual with a positive attitude and exceptional work ethic.