Accounts Receivable Specialist supports the operations of the revenue cycle team by identifying and resolving any claim delay issues that impact collections in a timely and accurate manner while adhering to local, state, and federal compliance guidelines. Provides team members support needed to assist in meeting accuracy and productivity goals, minimizing errors, rejections and denials via use of the charge capture system. Uses clinical knowledge and billing experience to compare the medical records documentation to patient account charge detail pertaining to individual items billed. Identifies and communicates trends of missing or misdirected charges to management to resolve charge capture related issues. Adheres to CodeOne Compliance Plan and to the rules and regulations of all applicable local, state and federal agencies and accrediting bodies. Coordinates with business office leadership to ensure compliance and current payer requirements are applied. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
Responsibilities and Duties
Identify and resolve any claim delay issues that impact collections.
Follow up on payment errors, low reimbursement, denials
Accurately interpret Explanation of Benefits (EOB).
Initiate and track appeals and reconsiderations as necessary.
Resolve Coordination of Benefit (COB) discrepancies.
Working directly with the insurance company, provider, and patient to get a claim processed and paid
Reviewing rejected and denied claims
Verifying patients’ insurance coverage
Reviews and abstracts information from patient records and assigns appropriate coding classification
Examines and reviews payer rejections, which includes educating internal staff
Interacts with appropriate contacts on billing related issues
Computer skills to include MS Office, Windows operating system, Internet, and ability to navigate through electronic health record systems
Other Skills and Abilities
Ability to work and meet deadlines in a fast-paced, dynamic, project-oriented environment through organization and time management skills
Basic understanding of CPT, HCPCS, ICD, and revenue codes
Knowledge of Medicare, Medicaid, third-party billing rules, coverage, payment, and compliance
Ability to read medical charts or dictation, understand services performed, and correlate those services to charges on the claim
Self-motivated, detail-oriented focus, and outstanding customer service skills