AR Ops Lead

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

📋 Description

• Accountable for offering support, coaching, and training to team members, including new recruits.

• Assist and collaborate with the Team, Supervisor, and Management on intricate inventory matters and issue resolution.

• Oversee all facets of billing, follow-up, and collection efforts for all payers.

• May manage a substantial dollar inventory desk or complex accounts and provide just-in-time staffing, handling inventory for team members who are absent or experiencing backlogs.

• May participate in special projects assigned by management, serving as a point of contact for internal operational inquiries.

• Work autonomously as well as in close cooperation with management and the team to take appropriate measures in resolving accounts.

• Execute assigned duties in a professional manner, which includes liaising with insurance plans, patients, physicians, attorneys, and team members as required.

• Possess basic computer skills to navigate various system applications available for additional resources in determining account actions.

• Access payer websites and extract relevant information to address account issues.

• Employ all provided job aids appropriately in Patient Accounting procedures.

• Record clear and concise notes in the patient accounting system regarding claim status and any actions taken on accounts.

• Achieve department daily productivity targets by processing a specified number of accounts while meeting quality standards set by leadership.

• Identify and report any issues such as system access, payer behavior, account workflow inconsistencies, or other opportunities for insurance collection.

• Provide assistance for team members who may be absent or facing backlogs.

• Engage in high-level problem-solving with an emphasis on compliance and the Revenue Cycle.

• Aid in the training and development of new employees and address subsequent training needs. Provide assistance, coaching, and training to staff members and enhance training efforts to boost production, quality, and collections. Participate in the peer interviewing process for new hires. Attend various conference calls, webinars, or advanced training to assist team members. Respond promptly to emails and phone messages from staff, management, and clients.

• Assist with special projects as assigned, documenting findings and communicating results. Help management keep projects on schedule for timely completion. Report the flow of daily operations and the impact of daily challenges for supervisor review.

• Utilize advanced problem-solving techniques with a focus on compliance to identify system and operational issues. Recognize chronic recurring problems and propose innovative solutions to Leadership and business partners.

• Identify potential delays and trends with payers, such as corrective actions, and respond proactively to avoid A/R aging. Timely escalate payment delays or problematic aged accounts to the Supervisor. Generate required reports (daily, weekly, monthly). Research each account using company patient accounting applications and online resources. Conduct appropriate account activities on uncollected balances by contacting third-party payers and/or patients via phone, email, or online. Update plan IDs, adjust patient or payer demographic/insurance information, document account details thoroughly, and resolve recoup issues. Request additional information from patients, medical records, and other documentation as needed by payers. Review all existing documentation, including but not limited to UB, IB, Explanation of Benefits (EOB), and Managed Care Contracts to verify claim balance calculations; ensure the integrity of supporting documentation. Confirm in the system that accounts have been adjudicated correctly once settled. If necessary, make adjustments to accounts as per legal requests. Identify billing or coding issues and request re-bills, secondary billing, or corrected bills as required. Take appropriate measures to achieve timely account resolution and initiate a dispute record for further research and substantiation for ongoing collection efforts, including completing technical appeals. Maintain desk inventory to stay current without backlog while meeting productivity and quality standards.

⛳️ Requirements

• High school diploma or equivalent.

• Some college education is advantageous.

• 3-5 years of experience in medical billing, collections, appeals, legal departments, and/or contract interpretation.

• Knowledge of Medical Record documentation.

• Familiarity with writing disputes (1st, 2nd, and 3rd level appeals).

• Ability to work independently and apply sound judgment and independence in problem-solving.

• Advanced proficiency in Excel and a strong command of all Microsoft Office products.

• Capability to multitask, meet deadlines, and adapt to changes.

• Professional communication skills to facilitate resolution of complex claims.

• Strong organizational abilities.

• Comprehensive knowledge of coding terminology, including HCPCS, Diagnosis & ICD-10, DRG & Revenue Codes.

• Intermediate understanding of Explanation of Benefits (EOB), Managed Care Contracts, contract language, and federal and state requirements.

• Intermediate knowledge of hospital billing form requirements (UB-04).

• Intermediate understanding of ICD-9, HCPCS/CPT coding, and medical terminology.

• Intermediate writing skills, including correct grammar and punctuation usage.

• Intermediate analytical and mathematical skills.

• Ability to coordinate accounts and document detailed information.

• Ability to conduct research and work independently.

• Capacity to thrive in a high-volume, fast-paced environment.

• Professional communication abilities.

🏝️ Benefits

• Medical, dental, vision, disability, and life insurance.

• Paid time off (vacation & sick leave) – minimum of 12 days per year, accruing at a rate of approximately 1.84 hours per 40 hours worked.

• 401k plan with up to a 6% employer match.

• 10 paid holidays each year.

• Health savings accounts, healthcare, and dependent flexible spending accounts.

• Employee Assistance Program and Employee Discount Program.

• Optional benefits including pet insurance, legal insurance, accident and critical illness insurance, long-term care, elder & childcare, AD&D, and auto & home insurance.

• For Colorado employees, Conifer provides paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.