Professional A/R Follow-Up Specialist (Remote)

Résumé du poste

The specialist will conduct comprehensive follow-up on outstanding physician claims to ensure timely reimbursement and resolve claim denials through root cause analysis. They will also serve as a liaison between providers, payers, and patients to manage billing discrepancies and maintain accurate account records.

Détails du poste

1. Conduct comprehensive follow-up on outstanding physician and provider claims to ensure timely resolution and reimbursement. 2. Analyze aged AR, identify trends, and prioritize accounts based on age, financial impact and payer requirements. 3. Reconcile account balances utilizing remittance advice, explanation of benefits and payer correspondence. 4. Investigate, resolve and prevent claim denials through root cause analysis and collaboration with internal departments. 5. Prepare and submit timely, compliant appeals with supporting clinical and billing documentation. 6. Track and manage denial workflows using payer systems and internal denial management tools. 7. Review claims for billing accuracy to ensure compliance with payer policies. 8. Serve as a liaison between providers, payers, and patients to resolve billing discrepancies and payment delays. 9. Communicate professionally with insurance carriers regarding claim status, underpayments and appeals. 10. Respond to inquiries while ensuring HIPAA compliance and service excellence standards. 11. Maintain working knowledge of CPT, HCPCS, ICD-10-CM, modifiers, occurrence codes, condition codes, span codes, and value codes applicable to assigned payer groups to effectively carry out the responsibilities of assigned insurance group(s). 12. Identify underpayments, missed revenue opportunities, and process improvements within the professional revenue cycle. 13. Support initiatives to enhance cash flow and reduce days in A/R. 14. Verify insurance information through eligibility verification, claim status review, payer portals, and individual insurance carrier websites. 15. Perform follow-up activities on unpaid accounts utilizing trial balances, payer correspondence, online portals, and other reports and claim listings as appropriate. 16. Calculate patient liability and perform system adjustments to support accurate patient statement billing as needed. 17. Monitor credit balance reports and performs analysis making appropriate claims adjustments and/or refunds as necessary. 18. Create and maintain logs and reports as needed to support Patient Account activities. 19. Provide cross-coverage and support for departmental operations, including training activities and coverage during staff absences. 20. Comply with departmental and organizational policies including but not limited to dress code, use of supplies, phones and computers. 21. Adheres to work schedules and maintains a safe and orderly work area at all times, maintaining awareness of and compliance with safety policies and procedures. 22. Attends and participates in educational programs, in-service meetings, workshops, and other activities as related to job performance, job knowledge and state regulations. 23. Analyze automated billing system output and reports to identify, research, and resolve outstanding accounts. 24. Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers. 25. Performs other job-related duties and assignments as requested. • Must read, write, and communicate in English • High School diploma or GED • (Preferred) Associate's or Bachelor's degree in Business, Healthcare Administration, or related field. Relevant healthcare experience may be considered in lieu of formal education. • Minimum of one (1) year of experience in professional/physician medical billing, including accounts receivable follow-up, denial management, and claim resolution. • Experience with electronic billing systems and payer portals • Working knowledge of professional billing workflows, CPT, HCPCS, and ICD-10-CM coding conventions, modifiers, medical terminology, and insurance billing guidelines. • Knowledge of HIPAA regulations • Proficiency with Microsoft Excel, Word, and Outlook • Strong analytical, organizational, and problem-solving skills, with exceptional attention to detail and the ability to manage multiple priorities in a fast-paced environment. • (Preferred) Experience using Epic or comparable electronic billing software

Ce que vous ferez

The specialist will conduct comprehensive follow-up on outstanding physician claims to ensure timely reimbursement and resolve claim denials through root cause analysis. They will also serve as a liaison between providers, payers, and patients to manage billing discrepancies and maintain accurate account records.

Exigences

Candidates must have at least one year of experience in professional medical billing, including accounts receivable and denial management. A high school diploma or GED is required, with a preference for an Associate's or Bachelor's degree in a related field.

Compétences indiquées

• Résolution de problèmes · Souhaitée
• Microsoft Excel · Souhaitée
• Accounts receivable · Souhaitée
• Communication · Souhaitée
• Microsoft Word · Souhaitée
• Microsoft Outlook · Souhaitée

Autres compétences pertinentes

Relevées dans la description du poste. Confirmez les exigences importantes ci-dessus.

• Medical billing
• Accounts receivable
• Denial management
• Claim resolution
• CPT coding
• HCPCS coding
• ICD-10-CM coding
• HIPAA compliance
• Microsoft Excel
• Microsoft Word
• Microsoft Outlook
• Analytical skills
• Problem-solving
• Communication
• Electronic billing systems
• Payer portals
• Epic EMR
• Healthcare Industry Knowledge
• Claims Adjustment
• Denial Management
• Claims Resolution
• Workflow Management
• State Regulations
• Research
• Accounts Receivable
• Automation
• Billing
• Medical Billing
• Calculations
• CPT Coding
• Electronic Billing
• English Language
• Healthcare Common Procedure Coding Systems
• ICD Coding (ICD-9/ICD-10)
• Problem Solving
• Medical Terminology
• Operations
• Remittance
• Process Improvement
• Root Cause Analysis
• Revenue Cycle Management
• Prioritization
• Explanation Of Benefits (EOB)
• Detail Oriented

Domaines d’emploi

• Healthcare
• Finance & Accounting
• Administrative
• Follow Up Specialist
• Billing Analyst
• Accounting and Bookkeeping Clerks
• Billing and Posting Clerks