Accounts Receivable Specialist 1

Essential Duties & Responsibilities:

• Verify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the insurance carrier/providers

• Update patient demographics/insurance information in appropriate systems - 

• Research/ Status unpaid or denied claims 

• Monitor claims for missing information, authorization and control numbers(ICN//DCN) 

• Research EOBs for payments or adjustments to resolve claim

• Contacts payers via phone or written correspondence to secure payment of claims

• Access client systems for payment, patient, claim and data info

• Follows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems

• Secure needed medical documentation required or requested by third party insurance carriers 

• Maintain and respect the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure

• Perform other related duties as required

Minimum Requirements & Competencies: 

• 1-2 years of medical collections/billing experience

• Basic knowledge of ICD-10, CPT, HCPCS and NCCI

• Basic knowledge of third party billing guidelines

• Basic knowledge of billing claim forms(UB04/1500)

• Basic knowledge of payor contracts

• Working Knowledge of Microsoft Word and Excel

• Basic working knowledge of health information systems (i.e. EMR, Claim Scrubbers, Patient Accounting Systems, etc.)

Preferred Requirements & Competencies: 

• Working knowledge of one or more of the following Patient accounting systems -  EPIC, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts or Paragon

• Working knowledge of DDE Medicare claim system

• Knowledge of government rules and regulations