SUMMARY

The Accounts Receivable Specialist I is primarily responsible for following up with insurance companies, diagnosing claim denials, escalating denial trends to RCM leadership, and processing self-pay billing. This role will directly communicate with insurance payers on claims that require additional review, reconsideration or appeals.

MINIMUM QUALIFICATIONS

• High School Diploma or equivalent required.
• Experience in using billing software and electronic health record systems required.
• Knowledge of medical insurance plans required.
• Knowledge of all medical billing, insurance guidelines, and appeals process preferred.
• Knowledge of healthcare EDI transactions and experience working with healthcare clearinghouses preferred.

SKILLS AND ABILITIES

• Strong analytical and problem-solving skills.
• Ability to develop and maintain positive, professional, service-oriented working relationships with senior leadership, patients, physicians, and other co-workers.
• Ability to work independently and proactively while prioritizing varied requests and tasks.

• Ensure that claims are paid and processed accurately and in a timely manner.
• Follow up on open claims, resolve denials, and correct and reprocess claims when needed.
• Maintain documentation throughout the claims process according to department policies (i.e. corrective actions, reference numbers, next actions).
• Collaborate with the AR team to identify root causes and address denial trends
• Write off uncollectable accounts and maintain compliance with all applicable policies and procedures
• Collaborate with the Billing Customer Service Team when patients request assistance with their accounts.
• Partner with clinical team members to obtain additional information as it relates to claims.
• Receive, respond to, and clearly document all incoming account inquiries.
• Continually meet productivity standards set by management.
• Adhere to DOCS policies and standards.
• Other duties as assigned.