Billing & Insurance AR Collection Specialist with experience in Urology

at  CalpionPlutus Health

ABOUT PLUTUS HEALTH INC.:

Plutus Health Inc. is a leading provider of Revenue Cycle Management (RCM) services with SOC2 Certification. We are dedicated to helping healthcare providers improve their financial performance. Our expertise spans across various specialties, including Urology. We are committed to delivering exceptional service and innovative solutions to our clients. As a result, Plutus Health Inc. has been recognized on the 5000 list of the fastest-growing private companies in America and ranked 100 in the Dallas area. Additionally, the company has been a 2024 finalist in the EY Entrepreneur Of The Year.

JOB SUMMARY:

We are seeking an experienced AR Caller with specialized knowledge in Urology billing and EPIC EMR experience. The ideal candidate will be responsible for managing accounts receivable tasks, including following up on claims, resolving outstanding balances, and ensuring timely reimbursement. This role requires strong communication skills, attention to detail, and a deep understanding of the unique challenges associated with Urology billing, with a focus on managing aging AR accounts.

QUALIFICATIONS:

• Experience: Minimum of 4-5 years of experience in AR calling, with a focus on Urology billing and collections, including out-of-network collections.
• Knowledge: Strong understanding of Urology treatment services, including relevant billing codes, payer requirements, and regulatory guidelines.
• Technical Proficiency: Experience with EPIC EMR is required, along with proficiency in using billing software, electronic health records (EHR), and Microsoft Office Suite, particularly Excel.
• Skills: Excellent communication skills, both verbal and written, with the ability to interact effectively with payers, patients, and internal teams.
• Attention to Detail: Meticulous in reviewing claims, identifying discrepancies, and ensuring accurate resolution.
• Problem-Solving: Strong analytical skills to investigate and resolve complex AR issues related to Urology services.
• Education: High school diploma or equivalent required; additional certification in medical billing or healthcare administration is preferred.

• Claims Follow-up: Proactively follow up with insurance companies and other payers to ensure timely resolution of unpaid claims, with a focus on Urology-related services.
• Denial Management: Analyze and address claim denials, rejections, and underpayments related to Urology treatments, ensuring accurate resubmission or appeal processes.
• Patient Account Management: Review and manage patient accounts, including verifying insurance coverage, calculating patient responsibility, and coordinating with patients for outstanding balances.
• Aging AR Management: Effectively manage and reduce aging accounts receivable, particularly accounts aging over 365 days, by implementing strategic follow-up and resolution techniques.
• Documentation: Maintain detailed and accurate records of all follow-up activities, payer communications, and claim statuses in the EPIC EMR system.
• Compliance: Ensure all activities comply with relevant regulations, payer guidelines, and company policies, particularly those related to Urology services.
• Collaboration: Work closely with billing, coding, and clinical teams to resolve issues and improve the overall revenue cycle process for Urology services.
• Reporting: Prepare and present regular reports on AR performance, including aging reports, denial trends, and recovery rates specific to Urology billing.