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Insurance Accounts Receivable Specialist

2 months ago

Gainesville, Florida, United States The Cardiac & Vascular Institute Full time
Job Summary

The Cardiac & Vascular Institute is seeking a highly skilled Insurance Accounts Receivable Representative to join our team. As a key member of our financial services department, you will be responsible for ensuring the accurate and timely processing of insurance claims, resolving denials and claim rejections, and maintaining a strong working knowledge of payer requirements.

Key Responsibilities
  • Insurance Claim Processing: Interpret insurance payer responses, request account level adjustments, submit appeals and claims reconsiderations, evaluate financial responsibility of patients, and resolve insurance denials and claim rejections.
  • Performance Targets: Meet or exceed the department's established performance targets (productivity and quality).
  • Reconsiderations and Appeals: Initiate and follow-up on reconsiderations and appeals.
  • Denial Trends and Root Cause Analysis: Exercise good judgment in escalating identified denial trends or root cause of denials to mitigate future denials, expedite the reprocessing of claims, and maximize opportunities to enhance front-end claim edits to facilitate first-pass resolution.
  • Uncollectible Accounts: Identify uncollectible accounts and perform accurate and timely write-offs (e.g., no authorization) adhering to department policy guidelines.
  • Electronic Claims Submission: Based on electronic payers' error reports, make appropriate corrections to optimize the electronic claims submission process.
Requirements
  • Education: High School Diploma or equivalent (GED).
  • Experience: 3 years' work experience in insurance accounts receivable.
Preferred Qualifications
  • Cardiology Experience: Previous experience in cardiology is preferred.
Additional Information

All your information will be kept confidential according to EEO guidelines.