A/r Specialist Iii

1 week ago

Concord, United States Dermatology Associates of Concord Full time

A/R Specialist III:
Summary:
The A/R Specialist III is responsible for performing comprehensive billing, collections, auditing, and accounting functions. Follows up on insurance accounts by researching past due claims, contacting insurance companies, and assisting patients coordinate benefits. Reconciles EDI files and posts insurance payments in practice management software. Verifies claims and medical codes and coding-based appeals, submits insurance claims, responds to insurance requests and audits, processes payments, writes timely appeals, and enters data on patient accounts. Codes general and surgical dermatology encounters along with dermatopathology, phototherapy, and cosmetic services. Provides audit support for the revenue cycle manager, interfaces sensitively with providers. Acts as the primary resource for admin staff with insurance queries. Reconciles charges in practice management software and EMR. Ensures billing records are accurate and current, and tracks and resolves discrepancies.

Essential Duties and Responsibilities include the following:

- Answers billing phone calls and supports registration and call center admins with eligibility and referral queries.
- Submits claims to insurance companies and third-party payers as needed for reprocessing.
- Codes and files patient encounters and clears pre-clearinghouse scrubs.
- Maintains productivity and accuracy standards.
- Query providers for coding clarification.
- Renders patient estimates and research medical necessity guidelines for general and surgical dermatology and phototherapy.
- Reviews all EDI rejections and resubmits with corrections.
- Processes insurance payments via EDI and reconciles accounts.
- Enters insurance claims, payments, adjustments, and denials on patient statements.
- Checks electronic billing and payment reports for accuracy.
- Follows up with third party payers on a regular and systematic basis to ensure timely collections.
- Writes and follows up on third party payer appeals.
- Obtains prior approval for surgical encounters.
- Keeps abreast of payer policy changes via monthly newsletters.
- Performs assigned billing and accounting functions in accordance with established policies and procedures.
- Assists with duties of the A/R Specialist I as needed.

Supervisory Responsibilities:

- This job has no supervisory responsibilities.

Education/Certification:

- Associate degree or equivalent in medical office billing experience. CPC, CCA, or CPB required.

Required Knowledge:

- Knowledge of medical billing, Massachusetts payer policies, EDI, medical coding, and insurance claim filing.
- Knowledge of basic accounting concepts.

Experience Required:

- At least 3-5 years medical billing experience.
Skills/Abilities:

- Office 365
- Strong time management and organizational skills.
- Ability to rapidly adapt to new technologies and work independently.
- Solid data entry and typing skills.
- Good communication and public relations abilities.
- Accuracy with ten-key by touch.
- Detail oriented.

Physical Requirements:

- Prolonged periods sitting at a desk and working on a computer.
- Must be able to lift up to 15 pounds at times.

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