Hybrid RCM AR Specialist

Crossroads Treatment Centers is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Position Overview
The Accounts Receivable Specialist will be accountable for working accounts receivable follow-up and is responsible for performing third party insurance follow-up in the Central Billing Office. The personnel within this position are responsible for accomplishing assignments in accord with established policy, procedure, and production standards. This position must be equally capable of working independently as well as part of a team. Research and account follow-up will be required to understand denials, denial trends, or any other issues preventing payment, employee will take the appropriate steps needed to resolve the account.
The Accounts Receivable Specialist will work in conjunction with RCM Manager/Director to identify coding and other billing error trends. The Accounts Receivable Specialist utilizes a variety of proprietary and external tools to research and resolve insurance claims. The Accounts Receivable Specialist will be required to contact insurance companies via phone or website.

***Hybrid Opportunity - Position will be fully in office during training period which may vary depending on candidate's ability to meet competency requirements. Once requirements have been met, the employee may transition to working three days in office per week and two days remote.

Essential Duties and Responsibilities include the following and other duties that are assigned.

•Performs all duties and responsibilities in accordance with local, state, and federal
regulations and company policies.
•Utilize and apply industry knowledge to resolve new and aged accounts receivables by working
various account types, including but not limited to professional claims, governmental and/or
non-governmental claims, denied claims, aged accounts, high priority accounts, high dollar
accounts, reimbursements, credits, etc.
•Leverage available resources and systems (both internal and external) to analyze patient
accounting information and take appropriate action for payment resolutions; document all activity
in accordance with organizational and client policies.
•Communicate professionally (in all forms) with payer resources to include websites/payer
portals, e- mail, telephone, customer service departments, etc.
•Maintain quality and productivity results at a level that meets departmental standards as
measured by a daily/weekly/monthly average.
•Reviews claims data and supporting documentation to identify coding and/or billing
concerns.
•Ability to interpret payer contracts and identify contract variances affecting
reimbursement.
•Utilize knowledge of the cash posting processing to obtain the necessary information to resolve
misapplied payments.
•Demonstrate clear proficiency in third-party billing requirements to include federal, state, and
commercial/managed care payers.
•Interpret claim scrubber edits/rejections and takes appropriate action necessary to resolve
issues.
•Seek resolution to problematic accounts and payment discrepancies.
•Prepare appeal letters for technical denials by accessing specific payer appeal forms,
submitting appropriate medical documentation, and tracking appeal resolution.
•Analyze accounts with critical thinking; consider payer contracts and billing guidelines to ensure one- touch resolution.
•Further responsibilities may include reviewing insurance credit balances to determine root cause and take the steps necessary to resolve the account.
•Identify denials trends, root cause, and A/R impact.
•Serve as a resource to other team members and assist Team Leads with identifying A/R and denials trends.
•Other Duties as Assigned.

Qualification Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Position requires constant mental alertness, attention to detail, and high degree of accuracy required in completing all assignments. Strong problem-solving skills. Smart, driven, exceptional work ethic. Must be able to:

•Be 100% self-sufficient with the accounts worked, showing expertise and knowledge working independently to meet production and quality, while utilizing critical thinking and a solution-oriented mindset. Will need to have the ability to take initiative when needed to share trends with leadership.
•Possess thorough understanding of physician billing, accounts receivable follow-up, and the account resolution process to include, but not limited to claims submission, acceptance and adjudication, transaction reviews, adjustment posting, denials & appeals processes, identification of patient responsibility, etc.
•Demonstrate an ability to meet all established department/client quality and productivity standards.
•Proven track record with working complex AR accounts from billing to resolution.
•Experience independently submitting technical appeals by following payer specific guidelines.
•Proven experience utilizing payer portals including but not limited to: Availity, NaviNet, Change, Waystar, and others. When working in portals must be able to identify the extent to which the payer portal was utilized: check eligibility, benefits, and authorization.
•Must be accustomed to working in a productivity/quality-based environment.
•Must be able to identify denial trends, root cause, and A/R impact to share with leadership.
•Knowledge related to third-party billing requirements, including federal, state, and commercial/managed care payers, and demonstrated compliance.
•Ability to efficiently work in a remote environment to include good time management skills and timely communication with co-workers.
•Required proficiency in the use of computers and computer software. Ability to use email and chat functions, navigate websites and portals, intermediate level of experience with spreadsheets, word processing and other required software applications.
•Strong written and verbal communication skills.

Follow oral and written instructions and follow -through on all assignments. Excellent organizational skills. Highly detailed-oriented. Ability to work well in a group setting and independently.

Education and/or Experience:
•Must have had at least 2 years accounts receivable experience in a physician office setting.
•General Knowledge of HCPCS, CPT-4 and ICD-10 coding and/or medical terminology.
•Familiar with multiple payer requirements and regulations for claims processing.
•Must have a High School Diploma/GED.

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