Medical Accounts Receivable Specialist

2 weeks ago

San Antonio, Texas, United States TEKsystems Full time

Position Overview:

The Medical Accounts Receivable Specialist plays a crucial role in the analysis, research, and resolution of complex customer accounts related to healthcare billing. This position involves handling high volumes of accounts receivable, addressing order entry discrepancies, and managing disputes tied to contractual agreements with various healthcare providers.

Key Responsibilities:

1. Conduct thorough reviews and reconciliations of initial Accounts Receivable and Order Entry discrepancies to ensure accurate invoicing and timely payments, adhering to established business practices.

2. Engage in extended resolution efforts for complex discrepancies, collaborating with departments such as Finance, National Contact Center, and Contracts to gather necessary transaction details for effective resolution.

3. Leverage advanced knowledge of accounts receivable practices and information systems to identify and eliminate barriers to successful account collection.

4. Research and validate all necessary transactional information, including contractual terms, service dates, and purchase order details, to support the resolution process.

5. Exercise independent decision-making based on a comprehensive understanding of various contractual pricing structures, ensuring compliance with established guidelines.

6. Participate in various tasks as assigned by management to support overall departmental objectives.

7. Uphold and enforce all company policies and procedures.

Specific Duties:

8. For each Medicare Insurance claim denial, develop a detailed account of patient product usage and history, substantiating the evidence required for appeals.

9. Draft concise and focused letters for Redetermination, Reconsideration, or Administrative Law Judge requests in accordance with Medicare policy.

10. Monitor and manage patient denials and partially paid claims to ensure timely completion of the Appeals Department's caseload.

11. Update the accounting system to reflect denial and payment statuses accurately.

12. Gather necessary documents and information from healthcare entities and Medicare portals to support the appeal of denied claims.

Required Skills:

Technical expertise in benefit administration, medical coding, and proficiency in Excel databases are essential. Strong customer service skills and experience in medical billing and call center environments are also required.

Qualifications:

A High School Diploma is mandatory. Candidates should possess 2-3 years of experience in medical collections, with the ability to analyze and resolve complex accounts receivable discrepancies and claim denials. Proficiency in Microsoft Excel and Word is necessary, along with excellent communication skills.

Experience in collections and accounts receivable, particularly with knowledge of Managed Care, Medicare, Medicaid, and HIPAA regulations, is highly desirable. Candidates should have a clear understanding of the collections process and how to appeal denied claims effectively.

Experience Level:

Intermediate Level

About TEKsystems:

TEKsystems is a leader in Full-Stack Technology Services and Talent Services, partnering with clients to drive transformation and seize new opportunities. With a global team of 80,000 professionals, we collaborate with over 6,000 clients, including a significant portion of the Fortune 500, across North America, Europe, and Asia. We are committed to fostering an inclusive workplace and are proud to be an equal opportunity employer.

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