Job Summary:

• Accounts Receivable (“AR”) Specialists are primarily responsible for analyzing collections, resolving non-payables, and handling bill inquiries for more complex issues. AR Representatives are responsible for insurance payer follow-up ensuring claims are paid according to client contracts. Complies with all applicable laws regarding billing standards.

Essential Functions and Tasks:

• Follows up on claim rejections and denials to ensure appropriate reimbursement for our clients
• Process assigned AR work lists provided by the manager in a timely manner
• Write appeals using established guidelines to resolve claim denials with a goal of one contact resolution
• Identified and resolved denied, non-paid, and/or non-adjudicated claims and billing issues due to coverage issues, medical record requests, and authorizations
• Recommend accounts to be written off on Adjustment Request
• Reports address and/or filing rule changes to the manager
• Check system for missing payments
• Properly notates patient accounts
• Review each piece of correspondence to determine specific problems
• Research patient accounts
• Reviews accounts and to determine appropriate follow-up actions (adjustments, letters, phone insurance, etc.)
• Processes and follows up on appeals. Files appeals on claim denials
• Scan correspondence and index to the proper account
• Inbound/outbound calls may be required for follow up on accounts
• Route client calls to the appropriate RCM
• Respond to insurance company claim inquiries
• Communicates with insurance companies for status on outstanding claims
• Meet established production and quality standards as set by Ventra Health
• Performs special projects and other duties as assigned

Education and Experience Requirements:

• High School Diploma or GED
• At least one (1) year in data entry field and one (1) year in medical billing and claims resolution preferred
• AAHAM and/or HFMA certification preferred
• Experience with offshore engagement and collaboration desired

Knowledge, Skills, and Abilities (KSAs):

• Intermediate level knowledge of medical billing rules, such as coordination of benefits, modifiers, Medicare, and Medicaid and understanding of EOBs
• Become proficient in use of billing software within 4 weeks and maintain proficiency
• Ability to read, understand, and apply state/federal laws, regulations, and policies
• Ability to communicate with diverse personalities in a tactful, mature, and professional manner
• Ability to remain flexible and work within a collaborative and fast paced environment
• Basic use of computer, telephone, internet, copier, fax, and scanner
• Basic touch 10 key skills
• Basic Math skills
• Understand and comply with company policies and procedures
• Strong oral, written, and interpersonal communication skills
• Strong time management and organizational skills
• Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills

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