Accounts Receivable Specialist II

This is a fully remote position, open to applicants in United States.

📋 Description

• Confirms or obtains patient eligibility and/or authorization for healthcare services by exploring payer websites or client eligibility systems, or by engaging in phone conversations with the insurance provider or healthcare professionals.

• Updates patient demographics and/or insurance details in the relevant systems.

• Conducts investigations and appropriately processes unpaid or denied claims.

• Monitors claims for missing information, including authorization and control numbers (ICN//DCN).

• Researches Explanation of Benefits (EOBs) for payments or adjustments to address claims.

• Contacts payers via phone or written correspondence to ensure claims payment.

• Accesses client systems for information related to received payments, outstanding claims, and other essential data required for claim resolution.

• Adheres to guidelines for prioritization, timely filing deadlines, and documentation protocols within the relevant systems.

• Secures medical documentation as necessitated or requested by third-party insurance carriers.

• Obtains billing guidelines and requirements by researching provider billing manuals.

• Composes appeal letters for technical appeals.

• Verifies the accuracy of underpayments by investigating contracts and claims data.

• In cases of authorization, coding, level of care, and/or length of stay denials, prepares claims for clinical audit processing.

• Supports Savista’s Compliance Program by following policies and procedures related to HIPAA, FDCPA, FCRA, and other laws applicable to Savista’s business practices.

⛳️ Requirements

• High school diploma or GED required.

• Minimum of two years of experience in healthcare insurance accounts receivable follow-up, working within or for a hospital/hospital system, directly dealing with government or commercial insurance payers.

• Experience in identifying billing inaccuracies and resubmitting claims, along with following up on payment discrepancies, low reimbursements, and denials.

• Proficient in reviewing EOB and UB-04 forms to perform accounts receivable activities.

• Comprehensive understanding of accounts receivable practices, medical business office procedures, coordination of benefit rules, denial appeals, and third-party payer billing and reimbursement procedures.

• At least two years of experience with accounts receivable software.

• Familiarity with navigating payer sites for appeals/reconsiderations, benefits verification, and online claims follow-up.

• Proven ability to navigate Internet Explorer and Microsoft Office, including inputting and sorting data in Microsoft Excel and utilizing company email and calendar tools.

• Demonstrated success in both individual and team-oriented work environments.

• Proven experience in effectively communicating with payers, comprehending complex information, and accurately documenting interactions.

• Ability to collaborate effectively with cross-functional teams to achieve objectives.

• Proven capability to meet performance targets.

🏝️ Benefits

• Comprehensive health, dental, and vision insurance.

• Retirement savings plan with company match.

• Paid time off and holidays.

• Opportunities for professional development and continuing education.

• A supportive and collaborative work environment.