Overview

Job Highlights

• Contacts insurance companies for status on outstanding claims.
• Processes and follows up on appeals to insurance companies.
• Refiles claims as needed.
• Works correspondence daily.
• Maintains basic proficiency with using spreadsheets.
• Audits adjustment requests and completes when appropriate.
• Resolves Manual Tasks assigned to AR for follow up.
• Works outstanding Accounts Receivable from assigned work queues.
• Meets productivity standards as set by the department.
• Maintains an accuracy rating of 97% or greater on audited accounts.
• Maintains strictest confidentiality.
• Works to become an SME across multiple workflows and various payers.
• Identifies and communicates trends to leadership.
• Provides peer payer and system training support.
• Gathers data and reports out in partnership with leadership.
• All other duties assigned.

Qualifications

KNOWLEDGE/SKILLS/ABILITIES (KSAs):

• Highschool graduate or equivalent.
• Associate or bachelor’s degree in business administration or related field of study is preferred.
• 1-3 years professional/healthcare preferred.
• 3+ years Accounts Receivable experience preferred.
• Excellent verbal and written skills to maintain professionalism in all methods of communication.
• Basic math skills for calculating anesthesia units, proper reimbursement, and percentages for appropriate adjustments.
• Understanding of Medical terminology.
• Advanced knowledge of insurance processing, guidelines, laws, and EOBs.
• Knowledge of managed care, Medicare, and Medicaid guidelines.
• Data entry skills with high accuracy.
• Knowledge of CPT, ICD-10 and ASA codes.
• Good problem-solving skills.
• Decision making ability with sound judgement.
• Strong analytical skills and attention to detail.
• Skill in gathering and reporting information.
• Ability to work effectively with staff, physicians, and external customers.
• Must have a pleasant disposition and high tolerance level.
• Must be able to work as part of a team.
• Ability to work independently with limited supervision.
• Must be a self-motivator and goal oriented.
• Skilled in computer applications including MS Word, MS Excel, MS Outlook, and MS Teams.
• Communicated well with the public.
• The physical demands described here are representative of those that may need to be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Occasional Standing
• Occasional Walking
• Frequent Sitting
• Frequent hand, finger movement
• Use office equipment (in office or remote)
• Communicate verbally and in writing