Insurance Accounts Receivable Specialist III

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

📋 Description

• The Insurance Accounts Receivable Specialist III is responsible for managing the most intricate claim situations and plays a vital role in mentoring team members while addressing escalated issues.

• Key duties involve resolving claims from out-of-network providers, drafting and reviewing appeals, assisting in training initiatives, and being a resource for colleagues.

• Execute billing-related assignments that include data entry, claim analysis, charge assessments, and follow-ups on accounts receivable.

• Concentrate on resolving complex insurance accounts, which encompass denials concerning medical necessity, non-covered services, bundling, out-of-network claims (OON), and other sophisticated claim scenarios.

• Handle a higher volume and complexity of tasks compared to Levels I and II, while ensuring quality and adhering to productivity standards.

• Complete daily responsibilities within assigned work queues per established workflows and managerial guidance.

• Employ CBO Pathways, payer websites, billing systems, and training resources to address unpaid or incorrectly paid claims and authorize procedures within designated timeframes.

• Recognize and escalate payer issues, credentialing inconsistencies, or coding problems to management as needed.

• Adhere to standard workflows as outlined in training materials and actively pursue further education or clarification when necessary.

• Analyze reports to uncover revenue opportunities and outstanding claims that require follow-up.

• Follow departmental workflows, regulatory mandates, and FGP compliance and patient confidentiality protocols.

• Effectively communicate with patients, providers, coders, and other stakeholders to ensure precise and prompt claims processing.

• Offer insights and feedback on system edits, billing practices, and procedural enhancements to bolster revenue cycle efficiency.

• Uphold patient confidentiality and consistently enforce policies and procedures to ensure compliance and operational uniformity.

• Collaborate with team members, support departmental objectives, and clearly articulate processes and procedures to others as necessary.

• Amend system records to fulfill payer requirements and resubmit claims accordingly.

• Train and mentor new employees and provide guidance to colleagues as required.

• Review and draft appeals while assisting staff in addressing complex claim or appeal-related inquiries.

• Perform additional duties related to the position as assigned.

⛳️ Requirements

• In-depth knowledge of billing systems, denial management, and payer-specific guidelines.

• Ability to coach, train, and guide other team members.

• Strong analytical and decision-making abilities; capable of managing complex accounts independently.

• Proficient in identifying trends, proposing solutions, and contributing to process enhancements.

• Experience in drafting appeals and managing escalated claim concerns.

• Proficiency in utilizing computer programs and applications, including Microsoft Office.

• High school diploma or equivalent is mandatory.

• An associate degree in a related field is preferred.

• Previous experience in a customer service or healthcare environment is required.

🏝️ Benefits

• Health insurance

• Dental insurance

• Vision insurance

• Life Insurance

• Pet Insurance

• Health savings account

• Paid sick time

• Paid time off

• Paid holidays

• Profit sharing

• Retirement plan