Medical Accounts Receivable Specialist

2 months ago

Richardson, United States MedicalWorx Staffing Full time
Job DescriptionJob Description

Job Summary: Responsible for all facets of medical billing and accounts receivable management including charge entry, payment posting, customer service and follow-up in accordance with practice protocol with an emphasis on maximizing patient satisfaction and profitability. Responsible for reviewing the patient demographic information in the practice management system at the time of charge entry to ensure accuracy and to provide feedback to the other front office staff regarding patient registration. Responsible for reviewing the physician’s coding at the time of charge entry to ensure accuracy, timely payments, and to maximize revenue. Responsible for submitting insurance claims both electronically once per day and on paper weekly.

Special Characteristics: This position requires a comprehensive understanding of accounts receivable management in a healthcare setting. This position requires strong working knowledge of Medicare and managed care plans, insurance carriers, referrals and precertification procedures. Also required is a strong working knowledge of CPT, ICD-10, HCPCS, modifiers, coding and documentation guidelines. Strong customer service, organizational and communication skills are essential to this position. In addition, strict adherence to write-off policies, refund policies and other accounts receivable policies as outlined in the Procedure Manual is required. This position requires an ability to prioritize multiple tasks simultaneously in an occasionally stressful environment. Also required are general computer skills, typing skills and a working knowledge of Medicare Compliance, OSHA and HIPAA.

Essential Functions:

  1. Input all charges related to the assigned physician’s professional services into the practice management system including office and hospital charges in accordance with practice protocol with an emphasis on accuracy to ensure timely reimbursement and maximum patient satisfaction. All charge batches should balance in both number of procedures and total dollar prior to posting.
  2. Post all payments, by line-item, received for physician’s professional services into the practice management system including co-payments, insurance payments, and patient payments in accordance with practice protocol with an emphasis on accuracy to ensure maximum patient satisfaction and profitability. All payment batches must be balanced in both their dollar value of payments and adjustments prior to posting.
  3. Post all credit and debit adjustments to patient accounts with strict adherence to the guidelines in the Procedure Manual.
  4. File all charge, payment and adjustment batches in the appropriate format by batch date for quick reference.
  5. Review the physician’s coding at charge entry to ensure compliance with Medicare guidelines and to ensure accurate and timely reimbursement.
  6. Provide customer service both on the telephone and in the office for all patients and authorized representatives regarding patient accounts in accordance with practice protocol. Patient calls regarding accounts receivable should be returned within 2 business days to ensure maximum patient satisfaction.
  7. Verify all demographic and insurance information in patient registration of the practice management system at the time of charge entry to ensure accuracy, provide feedback to other front office staff members and to ensure timely reimbursement.
  8. Follow-up on all outstanding insurance claims at 30-days from the date of service in accordance with practice protocol with an emphasis on maximizing patient satisfaction and practice profitability.
  9. Follow-up on all outstanding patient account balances at 60-days from the date of service in accordance with practice protocol with an emphasis on maximizing patient satisfaction and practice profitability using the A/R aged reports
  10. Provide information pertaining to billing, coding, managed care networks, insurance carriers and reimbursement to physicians, managers and subordinates.
  11. Follow-up on all returned claims, correspondence, denials, account reconciliations and rebills within five working days of receipt to achieve maximum reimbursement in a timely manner with an emphasis on patient satisfaction.
  12. Submit primary and secondary insurance claims electronically each day and on HCFA weekly to ensure timely reimbursement.
  13. Attendance at relevant seminars to remain abreast of current issues regarding vascular surgery accounts receivable, Medicare Compliance and HIPAA.
  14. Recommend accounts for outside collection when internal collection efforts fail in accordance with practice protocol.
  15. Process refunds to insurance companies and patients in accordance with practice protocol.
  16. Reconcile the incoming deposits in accordance with practice protocol as required to ensure timely payment posting.
  17. Monitor reimbursement from managed care networks and insurance carriers to ensure reimbursement consistent with contract rates.
  18. Monitor the supply and quality of forms, envelopes and supplies as required to perform job functions.
  19. Proficiency with all facets of the medical practice management system including patient registration, charge entry, insurance processing, advanced collections, reports and ledger inquiry.
  20. Provide cross coverage for the switchboard operator as required to ensure efficient and professional practice operation including lunch and break coverage.
  21. Proficiency with Availity, a web-based program for eligibility verification and claim status, to efficiently conduct accounts receivable follow-up and to maximize revenue.
  22. Maintain information regarding coding, insurance carriers, managed care networks and credentialing in an organized easy to reference format.

Education: High school diploma or GED is required. A college degree is preferred.
Experience: Requires a minimum of 3 years of accounts receivable experience preferably in a surgical or more preferably vascular surgery environment


Skills:

  1. The jobholder must demonstrate current competencies applicable to the job position.
  2. Requires excellent written and verbal communication skills and strong customer service skills.
  3. Requires strong basic mathematical skills.
  4. Requires a minimum typing speed of forty (40) words per minute and ten-key by touch.
  5. Requires an extensive working knowledge of managed care networks and insurance carriers.
  6. Requires an extensive working knowledge of accounts receivable functions including CPT and ICD-9 coding.
  7. Requires proficiency in general office automation including operation of fax machines, copy machines, adding machines, postage machines, and multi-line phone systems.
  8. Requires proficiency in working with a PC, the Internet, and MS Windows.
  9. Requires a good understanding of the current Medicare Compliance, OSHA, and HIPAA regulations.
Company DescriptionMedicalWorx Staffing is committed to making sure the performance of our employees meets or exceeds your productivity expectations. MedicalWorx wants to have a measurable impact on your culture and increase our value to your company. We can provide talented, qualified employees for temporary, contract to hire or direct hire positions or payroll services.Company DescriptionMedicalWorx Staffing is committed to making sure the performance of our employees meets or exceeds your productivity expectations. MedicalWorx wants to have a measurable impact on your culture and increase our value to your company. We can provide talented, qualified employees for temporary, contract to hire or direct hire positions or payroll services.

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