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Healthcare Accounts Receivable Specialist

2 months ago

Colorado Springs, Colorado, United States Gastro Care Partners Full time
Job Overview


Position Summary:
The Healthcare Accounts Receivable Specialist plays a crucial role in enhancing the financial performance of the department by executing charge entries, diligently pursuing all outstanding accounts receivable, addressing denial resolutions, and crafting effective written appeals to insurance carriers to optimize reimbursement for incorrectly denied claims. This specialist manages all communications related to insurance or patient accounts, engaging with carriers, patients, and other healthcare facilities as necessary to secure maximum payments and identify potential issues or changes.

Key Responsibilities:

  • Conduct thorough analysis of medical documentation to gather essential information for the accurate sequencing and assignment of ICD-10, CPT, and HCPS codes.
  • Review reports for errors and ensure data accuracy by validating and correcting as needed.
  • Collaborate with management in designated areas, providing insights regarding documentation challenges or recurring issues.
  • Ensure prompt follow-up on unpaid claims, resolve denials, and manage payer-related correspondence through appropriate research and appeal processes.
  • Address claim rejections, underpayments, and denials with the respective payer and initiate collection follow-ups on unpaid or denied claims, interpreting remittances to determine the best course of action.
  • Identify and analyze patterns of denials or billing practices, conducting in-depth account investigations as necessary to achieve resolution.
  • Engage with insurance carriers through phone calls, documenting all interactions in an electronic tracking system to ensure progress on outstanding accounts.
  • Coordinate third-party collections and strive for the successful reduction of outstanding balances for assigned divisions or projects.
  • Uphold patient confidentiality in accordance with compliance policies and HIPAA regulations.
  • Respond to inquiries from insurance carriers via various communication methods, demonstrating exceptional customer service.
  • Review and resolve uncollected accounts, preparing charge corrections and write-offs as needed.
  • Manage incoming and outgoing patient calls to oversee collections and address patient inquiries.
  • Participate in special projects as assigned.
Required Skills and Qualifications:
  • Strong problem-solving abilities.
  • Detail-oriented with excellent organizational skills.
  • Able to manage multiple tasks efficiently in a fast-paced environment.
  • Ability to build and maintain effective working relationships with patients, management, and colleagues.
  • Proficient in reading and interpreting EOBs (Explanation of Benefits) and understanding insurance contractual adjustments.
  • Advanced computer skills.
  • Able to prioritize tasks and work independently with minimal supervision.
  • Capable of handling a high volume of work with precision and speed.
  • Proven experience in collections and negotiation.
Education and Experience:
  • High school diploma or equivalent.
  • At least 2 years of experience in a dynamic medical billing environment.
  • Experience in a healthcare setting is essential.
  • Experience dealing with unpaid claims and denials.
  • Proficiency in MS Office applications.
  • Familiarity with CPT and ICD-10 coding is required; CPC certification is preferred.

About Gastro Care Partners:
Gastro Care Partners serves as the national partner for thriving regional gastroenterology practices. We believe in the principle that "medicine is local." Our organization equips high-performing regional practices with the necessary resources to excel in today’s evolving healthcare landscape while preserving their unique identities.