Overview
This role involves managing accounts receivable (AR) functions within a healthcare setting, ensuring accurate and timely billing and collections. Responsibilities vary depending on departmental needs.
Responsibilities
- Research and resolve outstanding patient and insurance credit accounts.
- Perform additional AR management research and update accounts to ensure claims are filed correctly.
- Process refunds or credit reversals promptly according to departmental policies.
- Prepare and fulfill government monthly credit reporting requirements.
- Accurately capture charges, review claims, edit postings in the AR system, and resolve charge edits.
- Handle denials related to charge capture to improve charge integrity.
- Update patient demographics, insurance registration, and verify insurance information.
- Consolidate duplicate guarantor/patient accounts accurately and timely.
- Review and process Accounts Receivables reports to ensure revenue integrity and identify reporting trends.
- Analyze payer variances based on contract modeling within the AR system.
- Understand payer and government contracts to confirm correct reimbursement amounts.
- Collaborate with other departments on revenue integrity issues including contract, charging, and AR issues.
- Manage account financial changes and refile claims to appropriate payers.
- Assist with payer/physician credentialing and system table management.
- Manage electronic remittance, eligibility, and claims agreements to ensure proper processing of electronic transactions.
- Process vendor claim updates, returns, and resubmissions for payment.
- Perform other duties as assigned.
Requirements
Education
- High School Diploma or equivalent.
Experience
- Minimum of 4 years in medical office or medical billing within hospital or physician billing settings, collections, or coding.
- Strong knowledge of CPT, HCPCS, and ICD-9/10 coding.
- Proficient in reading insurance Explanation of Benefits (EOB) and understanding remittance and remark codes.
- Good working knowledge of Microsoft Excel.
- Effective communication skills with the ability to interact across multiple departments and management levels.
Licenses/Certifications
Preferred Qualifications
- In-depth knowledge of all payer billing and eligibility requirements.
- Certifications such as Certified Procedural Coder (CPC or CPC-H), Certified Revenue Cycle Associate (CRCA), Certified Medical Insurance Specialist (CMIS), or Registered Health Information Technician (RHIT) are preferred.
Location
- Position based within a healthcare system in Spartanburg, South Carolina.