Accounts Receivable Representative I

Under the direct supervision of the Collections Supervisor or Manager, the Accounts Receivable Representative I is responsible for the effective and efficient denied claims management for assigned payers. Responsible for working high volume collection reports and correspondence, auditing accounts, submitting all levels of appeals for denied claims as necessary, updating accounts as needed, and identifying carrier-related denial trends. Maintains a thorough knowledge of all-payer types including CMS billing guidelines as well as the ability to interpret the content of managed care contracts.

Principal Duties and Responsibilities:

• Coordinates, monitors, and manages the follow-up on unpaid claims.
• Ensures follow-up and reimbursement appeals of unpaid and
• inappropriately paid claims.
• Identifies, researches, and ensures timely processing of billing errors
• and corrections as they relate to claims. Actively participates in problem
• identification and resolution and coordinates resolutions between appropriate parties.
• Ability to communicate and collaborate effectively with other internal
• as well as external resources to achieve desired results and
• resolve issues.
• Review and work on all daily correspondence. Appeals denied claims via mail,
• telephone or websites. Perform audits on accounts when needed to review for accuracy.
• Update accounts with information obtained through correspondence
• and telephone. When necessary contacts patients, referring providers or
• a hospital to obtain better insurance information, authorization, or updated
• patient demographics to assist with collections.
• Completes appropriate account maintenance by ensuring the correct statement groups, financial class, and payer codes. Accurately documents all follow up on the account to ensure there is an accurate record of the steps taken to collect on an account.
• Pitches in to help the completion of the daily AR Representative 1 & 2 workloads to support AR team productivity and outcome measures.
• Meets the current productivity standard which includes both quantity and quality metrics.
• Maintains a working knowledge and understanding of CPT and ICD-10 codes. Keeps current with health care practices and laws and regulations related to claims collections.
• Performs other job-related duties within the job scope as requested by Management.

The above statements reflect the general duties considered necessary to describe the principal functions of the job as identified and should not be considered a detailed description of all the work requirements that may be inherent to the position.

REQUIRED QUALIFICATIONS :

Education:

- High school diploma or equivalent certification required

- Associate degree or equivalent from a two-year college preferred; or equivalent combination of education & experience.

Experience:

- 3-5 years of prior experience in a fast paced and high volume corporate medical collection’s role.

- Knowledge of basic patient accounting processes and healthcare terminology strongly preferred

Knowledge, Skills, Abilities:

- Strong computer skills (including MS Word and Excel)

- Ability to maintain accuracy while working on multiple tasks in a fast-paced environment under low-to moderate supervision

- Excellent verbal and written communication skills, including professional telephone etiquette

- Ability to ensure confidentiality of sensitive information and maintain HIPAA compliance

- Dependable in both production and attendance

- Exceptional organization and time management skills

Total Rewards

• Salary: $13.50-20.20 per hour
• Generous benefits package, including:
  • Paid Time Off
  • Health, life, vision, dental, disability, and AD&D insurance
  • Flexible Spending Accounts/Health Savings Accounts
  • 401(k)
  • Leadership and professional development opportunities