AR Follow Up Representative

4 weeks ago

Miami, United States Rise Health Services Inc Full time
Job DescriptionJob DescriptionDescription:
  • The Accounts Receivable Specialist is responsible for the accurate and timely follow-up of unpaid and underpaid claims by assigned payer/s and defined aging criteria to meet or exceed collection targets and minimize write-offs
  • Researches claim denials by assigned payer/s to determine reasons for denials correcting and reprocessing claims for payment in a timely manner
  • Meets or exceeds the department’s established performance targets (productivity and quality)
  • Initiates and follows-up on appeals
  • Exercises good judgement in escalating identified denial trends or root cause of denials to mitigate future denials, expedites the reprocessing of claims and maximizes opportunities to enhance front end claim edits to facilitate first pass resolution
  • Identifies uncollectible accounts and performs accurate and timely write-offs (e.g. no authorization) adhering to IPM CBO policy guidelines
  • Demonstrates the ability to be an effective team player
  • Upholds “best practices” in day-to-day processes and workflow standardization to drive maximum efficiencies across the team
  • Accurate and timely follow-up on claims that have not received a response, have been denied, or have been under/over paid
  • Works with payer to determine reasons for denials
  • Corrects and resubmits claims for payment in a timely manner
  • Proceeds with appeals process as needed
  • Performs eligibility and claim status follow-up inquiries utilizing outbound calls to the payer, web link tools and payer websites
  • Documents all actions taken on accounts worked according to the department policy to ensure clear understanding of encounter status
  • Identifies root causes and denial trends and makes recommendations to department leadership to prevent additional denials
  • Maintains a strong working knowledge of payer requirements and can research payer policies including LCD’s and NCD’s to help determine root cause for denial trends
  • As a last resort after exhausting all efforts, performs accurate write-offs (e.g. no authorization) following the identification of uncollectible accounts
  • Participates in regularly scheduled team meetings sharing denial trends specific to claim requirements to enhance front end claim edits to facilitate first pass resolution
  • Contributes ideas for workflows and approaches to A/R follow-up tasks to maximize opportunities for performance, process, and net revenue collections improvement
  • Meets established productivity metrics for the AR Department
  • Meets routinely with Supervisor to review productivity results and understands best practices and opportunities to create efficiencies in order to achieve maximum performance
  • Meets established quality metrics for the AR Department
Requirements:
  • High School Graduate/GED required. Technical School/2 Years College/Associates Degree preferred.
  • Work experience: Experience (1-3 years minimum) working in healthcare revenue cycle
  • Healthcare (professional) billing, knowledge of CPT/ICD-10 coding, government, managed care and commercial insurances, claim submission requirements, reimbursement guidelines, and denial reason codes
  • Understanding of the revenue cycle and how the various components work together preferred
  • Excellent organization skills, attention to detail, research, and problem-solving ability. Results oriented with a proven track record of accomplishing tasks within a high-performing team environment. Service-oriented/customer-centric. Strong computer literacy skills including proficiency in Microsoft Office

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