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Accounts Receivable Retro Adjudication Specialist II #Full Time
2 months ago
** 61st Street Service Corporation**
** Accounts Receivable Retro Adjudication Specialist II #Full Time**
Fort Lee, NJ 07024
**The 61st Street Service Corporation**
At 61st Street Service Corporation we are committed to providing our client with excellent customer service while maintaining a productive environment for all employees. The Service Corporation offers a competitive comprehensive Benefit package to eligible employees; including Healthcare and various other benefits including Paid Time off to promote a healthy lifestyle.
We are an equal employment opportunity employer and we adhere to all requirements of all applicable federal, state, and local civil rights laws.
**Job Summary**:
The Accounts Receivable Retro Adjudication Specialist II is responsible resolving all transactions held for retro adjudication review, ensure claims are billed accordingly based on payer claim policies and/or bill the next responsible party. Responsibilities include validating patients insurance coverage, updating claims/accounts accurately and contacting patients, account guarantor and/or insurance carriers.
**Job Requirements**:
- Through an assigned work queues, the Accounts Receivable Retro Adjudication Specialist II will follow protocols to determine best course of action to follow up on open receivables.
- Applies strong technical knowledge of all aspects of billing and collections including billing policies, regulations, diagnosis and procedure coding, and applicable to determine resolution.
- Performs demographic and insurance coverage updates on account as appropriate and bill new insurance as appropriate.
- Contacts insurance companies and/or patient/guarantor through phone contact, correspondence, online portals and other approved means to obtain status of outstanding claims and submitted appeals.
- Reviews account history for continuous follow up.
- Addresses incoming correspondence and respond timely to ensure prompt resolution. Prepares correspondence to insurance companies, patient and/or guarantor, as necessary.
- Documents clearly in billing system the claim issue and course of action taken on every account worked. Documentation and action must be clearly noted for future follow up and review.
- Escalates issues and problems to Supervisor as appropriate.
- Identifies trends or pattern of persistent problems.
- Performs charge corrections based on payer and institutional policies.
- Performs other job duties as required and assigned, but not limited to job functions within the area of accounts receivable follow up.
- Conforms to all applicable HIPAA, Billing Compliance and safety policies and guidelines.
**Minimum Qualifications**:
- High school graduate or GED certificate is required.
- A minimum of 2 years experience in a physician billing or third party payor environment.
- Candidate must demonstrate a strong customer service and patient focused orientation and the ability to understand and communicate insurance benefits explanations, exclusions, denials, and the payer adjudication process.
- Must demonstrate effective communication skills both verbally and written.
- Ability to multi-task, prioritize, and manage time effectively.
- Functional proficiency in computer software skills (e.g. Microsoft Word, Excel and Outlook, E-mail, etc.)
- Ability to work independently and be a team player.
- The ideal candidate is a motivated individual with a positive attitude and exceptional work ethic.
**Preferred Qualifications:**
- Experience in Epic and or other of electronic billing systems is preferred.
- Knowledge of medical terminology, diagnosis and procedure coding is preferred.
- Previous experience in an academic healthcare setting is preferred.
