Medical Accounts Receivable Specialist

Medical AR Specialist 3

Under minimal supervision and with a high level of knowledge, skills and experience, Accounts Receivable Specialist 3 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.

• Responsible for their own appeal creations, reviewing and submitting first, second and third level appeals to insurance companies
  • Reviewing/submitting AR Specialist 2, level 2 and level 3 appeals
• Conduct root cause analysis and process improvement
• Responsible for filing all level 3 appeals to include: external appeals (DOI complaints & CMS complaints), member appeals
• Works special projects as assigned
• May present findings to management
• Uses independent judgement to solve issues
• Timely, effective follow up and maximize collection of assigned Third Party Payer outstanding A/R and denials.
• Analysis and timely reporting related to Third Party Payer A/R, denials and overall payer performance
• Trend, payer issue, cash flow disruption identification, tracking, reporting and resolution
• Processing, validation of payer requests and processed claims via correspondence, remittance advice and EOBs (i.e. identification of payment discrepancies, inappropriate requests)
• Timely, effective processing of assigned appeals including development, submission, tracking, reporting and evaluation of
  appeal outcomes (i.e. next steps, improved outcomes)
• Maximize utilization 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
• Must be able to work under minimal supervision
• Actively participates in team meetings, provides insight when asked
  • May be asked to present a topic during team meetings
• Meets Level 3 daily and monthly productivity requirements

• High school diploma (or GED equivalent)
• Minimum 5 plus years’ experience- all aspects of patient account management and resolution with an emphasis on 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 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
• Ensure compliance with all state and federal billing a HIPAA regulations
• Strong knowledge and experience with Microsoft Excel as well as Word and Outlook, general office equipment, ten key by touch
• Desire to learn and apply learned concepts to various situations
• Intermediate Xifin experience

In this Medical Accounts Receivable Specialist role at Hologic, you will play a pivotal role in shaping the future of women’s health. You’ll have the…