Accounts Receivable Specialist 2 (PB)

Overview

This role involves managing the timely collection of outstanding government or commercial healthcare insurance receivables. The specialist will work to verify patient eligibility, update insurance information, research unpaid or denied claims, and communicate with payers to secure payment.

Responsibilities

• Verify or obtain patient eligibility and/or authorization for healthcare services by searching payer websites, client eligibility systems, or contacting insurance carriers or healthcare providers.
• Update patient demographics and insurance information in appropriate systems.
• Research and appropriately status unpaid or denied claims.
• Monitor claims for missing information, authorizations, and control numbers.
• Research Explanation of Benefits (EOBs) for payments or adjustments to resolve claims.
• Contact payers via phone or written correspondence to secure payment of claims.
• Access client systems for information regarding received payments, open claims, and other necessary data.
• Follow guidelines for prioritization, timely filing deadlines, and notation protocols.
• Secure medical documentation as required or requested by third-party insurance carriers.
• Obtain billing guidelines and requirements by researching provider billing manuals.
• Write appeal letters for technical appeals.
• Verify accuracy of underpayments by researching contracts and claims data.
• Prepare claims for clinical audit processing in cases of authorization, coding, level of care, or length of stay denials.
• Support compliance programs by adhering to policies related to HIPAA, FDCPA, FCRA, and other applicable laws, including confidentiality and ethical standards.

Requirements

• High school diploma or GED.
• Minimum of three years' experience in healthcare insurance accounts receivable follow-up, preferably with hospital systems and government or commercial insurance payers.
• Experience identifying billing errors, resubmitting claims, and following up on payment errors, low reimbursements, and denials.
• Proficient in reviewing EOBs and 1500 forms for accounts receivable activities.
• Knowledge of accounts receivable practices, medical business office procedures, coordination of benefits rules, denial overturns, and third-party payer billing and reimbursement procedures.
• At least three years of experience with accounts receivable software.
• Experience navigating payer websites for appeals, benefits verification, and online claims follow-up, including Medicare and Medicaid.
• Proficient with Internet Explorer and Microsoft Office, including data input and sorting in Excel, and use of email and calendar tools.
• Strong communication skills for effective interaction with payers and accurate documentation.
• Ability to work collaboratively with cross-functional teams.
• Demonstrated ability to meet performance objectives.
• Productivity expectations: 55 claims per day / 275 claims per week.

Preferred Qualifications

• Experience with Epic software.
• Experience handling both hospital (facility) and physician (professional fee) accounts receivable.

Compensation & Benefits

• Salary range: $19.00 to $21.00 per hour, varying based on geographic location, experience, certifications, and skills.

Equal Opportunity Statement

The employer is an Equal Opportunity Employer and does not discriminate based on race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity, or any other protected class under federal, state, or local law.