Accounts Receivable Escalation Specialist

Overview

This role involves working as an Accounts Receivables Escalation Specialist responsible for analyzing collections, resolving non-payables, and handling complex billing inquiries. The specialist will follow up with insurance payers to ensure claims are paid according to client contracts and comply with all applicable billing laws.

Responsibilities

• Follow up on claim rejections and denials to secure appropriate reimbursement.
• Process assigned accounts receivable work lists promptly.
• Write appeals using established guidelines to resolve claim denials aiming for one-contact resolution.
• Identify and resolve denied, unpaid, or non-adjudicated claims due to coverage issues, medical record requests, and authorizations.
• Recommend accounts for write-off via Adjustment Requests.
• Report address and filing rule changes to management.
• Verify missing payments in the system.
• Properly document patient accounts.
• Review correspondence to determine specific issues.
• Research patient accounts and determine appropriate follow-up actions such as adjustments, letters, or insurance calls.
• Process and follow up on appeals, including filing appeals on claim denials.
• Scan and index correspondence to the correct accounts.
• Conduct inbound and outbound calls as needed for account follow-up.
• Respond to insurance company claim inquiries and communicate about outstanding claims.
• Meet established production and quality standards.
• Perform special projects and other duties as assigned.

Requirements

• High School Diploma or GED.
• Minimum of one year experience in data entry and one year in medical billing and claims resolution preferred.
• AAHAM and/or HFMA certification preferred.
• Experience with offshore engagement and collaboration is desired.

Knowledge, Skills, and Abilities

• Intermediate knowledge of medical billing rules including coordination of benefits, modifiers, Medicare, Medicaid, and explanation of benefits (EOBs).
• Ability to become proficient with billing software within 5 weeks and maintain proficiency.
• Ability to read, understand, and apply state and federal laws, regulations, and policies.
• Strong communication skills to interact professionally with diverse personalities.
• Flexibility to work in a collaborative, fast-paced environment.
• Basic computer skills including telephone, internet, copier, fax, and scanner usage.
• Basic 10-key data entry and math skills.
• Understanding and compliance with company policies and procedures.
• Strong oral, written, and interpersonal communication skills.
• Strong time management and organizational skills.
• Proficiency with Outlook, Word, Excel (including pivot tables), and database software.

Compensation and Benefits

• Base compensation will be determined based on factors such as geographic location, skill set, experience, qualifications, and other job-related considerations.
• This position is eligible for a discretionary incentive bonus according to company policies.

Location

Not specified.

Equal Employment Opportunity

The employer is committed to fostering a culturally diverse and inclusive workplace. All qualified applicants will receive consideration without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity or expression, or veteran status. Reasonable accommodations will be provided to qualified individuals with disabilities as needed.