Accounts Receivable Specialist - Hospitals

JOB PURPOSE:

The Accounts Receivable Specialist is primarily responsible for effective collection of patient accounts, accounts receivable follow-up, and reimbursement analysis for all non-government accounts to ensure timely and maximum reimbursement for client HOSPITALS.

ESSENTIAL FUNCTIONS INCLUDE BUT NOT LIMITED TO:

• Manage assigned accounts to ensure outstanding and pending claims are resolved and paid at maximum reimbursement in a timely manner.
• Request claim reprocessing when appropriate and prepare and submit corrected claims as needed.
• Conduct follow-up on all outstanding insurance claims beginning at 30 days from date of service.
• Review and resolve credit balance accounts, including payer and patient refund requests and misapplied payments or adjustments.
• Address returned claims, correspondence, denials, account reconciliations, and rebills within two working days of receipt.
• Identify and communicate denial trends to the Revenue Cycle Manager.
• Maintain working knowledge of insurance guidelines, including HMO, PPO, Medicare, and Medicaid.
• Demonstrate knowledge of institutional and professional billing requirements, including UB-04 (CMS-1450) and CMS-1500 claim forms.
• Obtain necessary documentation or clarification from facilities to resolve claims.
• Ensure compliance with state and federal regulations, payer guidelines, and company policies and procedures.
• Assist in developing, implementing, and improving revenue cycle processes.
• Maintain strict confidentiality of patient and financial information.
• Support management with special projects and perform other duties as assigned.

BEHAVIORAL STANDARDS:

• The individual must support the mission, vision, and goals of Avem Health Partners and serve as a role model within the company.
• Exhibit positive customer service behavior in everyday work interactions.
• Demonstrate a courteous and respectful attitude to internal workforce and external customers.
• Communicate accurately and appropriately.
• Handle difficult situations in a discreet and professional manner.
• Hold self-accountable for professional practice.
• Demonstrate knowledge of unit goals and is active in committees and projects to achieve these goals.
• Keep current with literature regarding changing practices, interventions, and best practices in patient care.
• Assume responsibility for seeking out educational and professional opportunities for personal learning needs and growth as well as meeting mandatory education requirements.
• Act as a preceptor as requested.
• Demonstrate excellent work attendance and attend and actively participate in a variety of meetings and training sessions as required.
• Adhere to the Avem Health Partners Code of Conduct and Standards of Behavior. Complies with established policies and procedures and all health and safety requirements.

EDUCATION:

• High school diploma or equivalent
• At least two years of medical accounts receivable experience

CERTIFICATION/LICENSURE:

• Medical billing certification, if available.

PHYSICAL REQUIREMENTS:

• To perform this job successfully, an individual must be able to perform each essential job duties satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant to be considered.
• This job requires visual abilities, auditory abilities, must be intact to perform duties.