Accounts Receivable Specialist

📋 Description

• Executes advanced level responsibilities related to denial management.

• Expertly processes and follows up on all types of appeals with all payers.

• Takes proactive measures to resolve outstanding claims as necessary, including refiling or appealing claims, or addressing manual tasks assigned to Accounts Receivable for review.

• Manages outstanding accounts receivable for designated projects.

• Acts as a Subject Matter Expert (SME) across various workflows and payers.

• Provides training support for peers regarding payers and systems.

• Detects denial trends and escalates issues to management for further investigation and/or root cause resolution.

• Suggests improvements for work queues and claim edits to enhance efficiency and minimize denials.

• Reviews communications from payers concerning changes in medical and reimbursement policies.

• Investigates payer trends identified by offshore partners to propose training and process enhancements.

• Recognizes opportunities for and actively engages in process improvement initiatives.

• Upholds the highest level of confidentiality.

• Demonstrates basic proficiency in spreadsheet usage.

• Adheres to productivity and quality standards set by Revenue Cycle Management (RCM).

• Performs any other duties as assigned.

⛳️ Requirements

• High school diploma or equivalent.

• Associate or bachelor’s degree in business administration or a related field is preferred.

• A minimum of 3 years of experience in accounts receivable is preferred.

• Exceptional verbal and written communication skills to maintain professionalism across all communication methods.

• Basic mathematical skills for calculating anesthesia units, proper reimbursements, and percentages for accurate adjustments.

• General understanding of medical terminology.

• Advanced knowledge of insurance processing, payer policies, guidelines, and explanations of benefits (EOBs).

• Familiarity with commercial payer, Medicare, and Medicaid guidelines.

• High accuracy in data entry skills.

• General knowledge and understanding of CPT, ICD-10, and ASA codes.

• Strong problem-solving abilities.

• Capacity for decision-making with sound judgment.

• Excellent analytical skills and attention to detail, including the ability to gather and consolidate information.

• Ability to collaborate effectively with all team members, including physicians and external vendors or patients.

• Must be capable of working in a virtual team setting.

• Ability to work independently with minimal supervision.

• Proficient in computer applications including MS Word, MS Excel, MS Outlook, and MS Teams.

🏝️ Benefits

• Eligible for a quarterly bonus.