Medical Accounts Receivable Specialist

Medical AR Specialist

Under general supervision and with a high level of knowledge, skills and experience, the Medical Accounts Receivable Specialist performs a variety and full range functions related to Biotheranostics customer service, billing, appeals and accounts receivable resolution.

Functions include but are not limited to billing, Third Party Payer follow-up, trend and A/R analysis, account inquiry resolution and appeals. In addition to specific duties, position may assist in other areas as needed to minimize risks related to achieving financial performance.

• Timely, effective follow up and maximize collection of assigned Third Party Payer outstanding A/R and denials.
• Responsible for reviewing and submitting first level appeals to insurance companies, collaborating with Level 3 reps on second level appeals and forwarding third level appeals to Level 3 reps to submit (level 3 appeals include: external appeals (DOI complaints & CMS complaints), member appeals)
• Analysis and timely reporting related to Third Party Payer A/R, denials and overall payer performance.
  • Investigate rejected claims to see why denials were issued and correct claims within the timeline period, while closely working with the provider associated with specific claim(s).
• Trend, payer issue, cash flow disruption identification, tracking, reporting and resolution.
  • Escalates to the payor and/or patient accounts that need to be appealed due to improper billing, coding and/or underpayments/refund requests.
  • Reports new/unknown billing edits to direct supervisor for review and resolution.
• Identify, report root causes associated with denials.
• Processing, validation of payer requests and processed claims via correspondence, remittance advice and EOBs (i.e., identification of payment discrepancies, inappropriate requests)
• Reviews and completes payor correspondence in a timely manner.
• Timely, effective processing of assigned appeals including development, submission, tracking, reporting and evaluation of appeal outcomes (i.e., next steps, improved outcomes)
• Intermediate knowledge of Billing system, tools and resources to support cash collection activities.
• Keep current with all payer regulations, guidelines and provider/payer contract terms.
• Effectively manage incoming calls, resolve internal and external customer inquiries regarding all aspects of patient and/or client accounts
• Support and maintain department cash and DSO goals.
• Data entry, correct insurance assignment to patient accounts, insurance eligibility verification. Review/update demographics and patient information for accuracy.
• Performs additional tasks, projects, special assignments as required.
• Works independently with Level 3 guidance.
• Actively participates in team meetings, provides insight when asked.
• Meets Level 2 daily and monthly productivity requirements.

• High school diploma (or GED equivalent)
• Minimum 3 plus years’ experience- all aspects of patient account management and resolution with an emphasis in Third Party Payers, A/R and denial resolution, preferably in a laboratory environment
• Must be able to demonstrate strong knowledge of commercial and government health plan requirements, guidelines, billing practices and regulations.
• Support cross-trained culture.
• Ability to easily adapt to increased business demands.
• Ability to effectively work with and resolve complex accounts & billing issues.
• Self-starter, ability to work independently.
• Excellent troubleshooting and time management skills, attention to detail, utilizes time in a constructive manner.
• Flexible and reliable
• Ability to effectively prioritize and multi-task.
• Ability to work in a fast-paced environment, perform under pressure, meet tight timelines.
• Establish and maintain cohesive and good working relationships.
• Excellent communication and customer service skills; cooperative, work collaboratively and treat others in respectful, professional and supportive manner.
• Working knowledge of ICD-10, CPT, LCD/NCD and reimbursement associated with such codes.
• Ensures compliance with all state and federal billing HIPAA regulations.
• Strong knowledge and experience with Microsoft Excel as well as Word and…