Accounts Receivable

Cumberland, RI

Post Date: 06/07/2017 Job ID: 22184 Category: Admin

Shift:
  • Mon- Fri 8: 30am- 5: 00pm

Position Summary:

  • This position is responsible, under the supervision of the Supervisor and Manager of the Accounts Receivable Dept.
  • Manage a high volume of medical claim corrections to ensure clean claim submission to the contracted health plans.
  • Refute payer denials through accurate review, correction, and resubmission of medical claims.
  • Provide representation when needed of the Accounts Receivable area assigned to internal dept. As well as external dept. And clients, vendors and processors to clearly relay situational occurrences and provide support when needed.
  • The account receivable associate will be responsible for identifying and quantifying trends/issues, developing potential solutions and then effectively communicate them to the appropriate members of the management team along with what the potential impact could be.
  • Effectively prioritize and manage outstanding receivable to support the reduction of key metrics including DSO, cost to collect, percent of aged claims, and Bad Debt.
  • Identify and implement process efficiencies across the dept. Including automation opportunities or workflow enhancement opportunities to reduce manual efforts and improve productivity and overall collections.
  • Recognize and Identify coding deficiencies and exercise the appropriate action based upon compliance and regulations.
  • Help support management staff with training of new employees as well as existing employees when needed.
  • The Accounts Receivable Associate will be accountable for the outstanding receivable within their appointed area(s).
  • This will include prioritizing, analyzing and trending the incoming volume of claims and executing a process to effectively reduce the amount of current and older AR with the intent of closing all claims within a compliant and timely manner.
  • Additionally the Accounts Receivable Associate is responsible to stay within compliance to all regulations regarding the amount of time it takes to return all overpayments to Government and Commercial plans.
  • This position also supports the billing call center in making outbound calls to insurance companies on behalf of the patient to refute or obtain a clear explanation on why the member is receiving a statement.
  • This position will also support the field providers by becoming a resource for them to assist with any AR related issues or concerns for their area as well as assist the management team in training new and existing AR staff when needed.
  • If a billing error is identified proper actionable steps must be taken to correct and resubmit the claim.
  • Lastly, this person will act as a representative for the area they are responsible for with internal dept. As well as external payers and vendors.

Responsibilities:
  • Identify all front end finance claim holds and take the necessary approved steps and actions to submit a clean claim to payer or the appropriate financial class for the claim.
  • All front end holds are identified in the billing system within the claim work queues or from weekly reporting separately from clearing house denials and payer denials.
  • These claims must be reviewed to determine what can be sent through automation and what needs to be prioritized and worked immediately based on timely filing guidelines and next actions.
  • Policy and procedure guidelines must be followed to ensure any changes made to a claim by the AR dept. Are within compliantly regulated limitations.
  • Identify all finance related denials received from payers and clearing houses to either make corrections to the claim and resubmit or take the appropriate action to transfer the claim to the next appropriate status based on the particular claims situation.
  • All back end holds are identified in the billing system within the claim work queues or the weekly reporting separately from front end holds/scrubs.
  • These claim must be reviewed to determine what can be sent through automation avenues and what needs to be prioritized and worked immediately based on timely filing guidelines and next actions.
  • Policy and procedure guidelines must be followed to ensure any changes made to a claim by the AR dept. Are within compliantly regulated limitations.
  • Identify key inefficiencies in daily tasks and activities to work with management on developing process improvements to increase productivity, quality and increase the average number of claims that can be worked.
  • Understand the front end registration and claim creation process to track trends and communicate improvements to the field providers with the intent to reduce the amount of backend claim clean up.
  • Reach out to payer provider representatives to clearly identify when a claim issue has occurred and create a plan of action to resolve the issue in the most efficient manner.
  • Research and investigate denial trends using various Microsoft applications with the intent of resolving large volumes of claims at one time.

Qualifications:
  • Proven individual or team accomplishments affecting industry related metrics (i.E. Productivity measures, Days Sales Outstanding or DSO, Bad Debt, Aged account clean up, etc.).
  • Understanding of CPT and ICD-9/ICD-10 billing and coding guidelines.
  • Understanding and complying to HIPPA/PHI regulations.
  • Microsoft Office Suite (with a focus on Excel, Word, and Outlook with intermediate level minimum knowledge).
  • Excellent written and verbal communication skills with vendors and payers, internal dept.
  • Computer literacy, subject knowledge, attention to detail, ability to multitask, ability to travel, etc.).
  • At least 1-3 Years prior medical billing experience.
  • Superior time management skills and the ability to multi-task.

Education:
  • Verifiable High School Diploma or GED is required.

A-Line Staffing Solutions

877-872-3334

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