AR Specialist

Main Function

Reports directly to the Billing Manager and responsible for submitting claims and statements to third-party payers and guarantors. Maintains correspondence regarding billing questions and fields calls regarding billing. Works on reducing company AR. Collects on insurance and patient balances. Responsible for understanding and verifying coding on all procedures within regulatory mandates. Other responsibilities as defined below.

Position Title: On Site AR Specialist

Reports to: Billing Manager

This position features:

Generous pay and benefits including a 401k and profit-sharing plan

Duties and Responsibilities

• Responsible for ensuring correct coding (modifiers, codes) is submitted for ancillary (physical therapy, DME, home health), clinical and or surgical claims to insurance company as necessary for submission or appeal of correct/clean claims.
• Understands and abides by billing compliance regulations including unbundling, correct use of modifiers etc. Understands concept of unbundling and heeds government regulations.
• Compiles pertinent medical records information, i.e., chart notes, diagnostic imaging reports, op notes, etc. and submits claims (appeals) to insurance companies.
• Reviews and documents insurance and patient correspondence in the system in a timely manner.
• Updates patient information in computer, i.e., insurance information, demographics, etc. when notified of changes by the patient
• Researches accuracy of insurance payments received/posted, accuracy of adjustments when required for billing or fielding billing questions from patients/insurance companies.
• Provides support to verifications, procedure authorizations and patient balance inquiries.
• Is the gatekeeper for clearinghouse messages and correspondence in assistance with Revenue Cycle Manager.
• Maintains payment plans and follow up on past due accounts for patient balances and insurance appeals.
• Works toward reducing AR by reviewing and posting necessary adjustments.
• Conducts audits on posting and collections of clinic batches
• Process refund request according to internal policies in a timely manner.
• Reviews and processes patient refunds
• Assists with AR recovery of patient and insurance collection.
• Other duties as assigned

Qualifications

• Cooperative work attitude toward co-employees, management, patients, visitors, outsourced companies and physicians
• Ability to promote favorable facility image with physicians and general public
• Ability to make decisions and solve problems.
• Ability to analyze and interpret data.
• Ability to research and prepare comprehensive reports/summaries.
• Ability to communicate clearly and effectively in writing and verbally.

Requirements

To perform this job successfully, an individual must be able to perform each of these tasks satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations will be made to enable individuals with disabilities to perform these essential functions.

1. Education: High school graduation or GED or one year of related experience and/or training or an equivalent combination of education and experience.
2. Language Ability: Able to read and comprehend simple instructions, short correspondence or memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients and other employees of the organization. Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar. Spanish speaking is preferred, but not required.
3. Math Ability: Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions and decimals. Ability to compute ratios, rate and percent and to draw an interpret bar graphs.
4. Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
5. Computer Skills: Basic computer skill and operational knowledge are preferred.
6. Certificates and Licenses: None required. CPC or other coding certification preferred
7. Personal Skills: Multi-tasking, Flexibility, Telephone Skills, Customer Service, Time Management, Organization, Attention to Detail, Scheduling, Word Processing, Professionalism, Quality Focus. The ability to work well under pressure and an awareness and understanding of other cultures are also important.
8. Supervisory Responsibilities: There are no supervisory responsibilities for this position.

We are an equal opportunity employer

Ellis & Badenhausen Orthopaedics, PSC is an equal opportunity employer. All qualified applicants will receive consideration without regard to race, creed, gender, marital status, sexual orientation, color, religion, national origin, age, disability, veteran status, or any other status protected under local, state, or federal laws. Applicants must be eligible to work in the USA.