Senior Accounts Receivable Specialist Location Greenville, SC : Crossroads Treatment Centers is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. Position Overview The Sr. Accounts Receivable Specialist will be accountable for working accounts receivable follow-up complex in nature and is responsible for performing third party insurance follow-up in the Central Billing Office. The personnel within this position are responsible for accomplishing assignments in accord with established policy, procedure, and production standards. This position must be equally capable of working independently as well as part of a team. Research and account follow-up will be required to understand denials, denial trends, or any other issues preventing payment, employee will take the appropriate steps needed to resolve the account. The Senior Accounts Receivable Specialist will be accountable for working accounts receivable follow-up complex in nature and is responsible for performing third party insurance follow-up in the Central Billing Office. The personnel within this position are responsible for accomplishing assignments in accord with established policy, procedure, and production standards. This position must be equally capable of working independently as well as part of a team. Research and account follow-up will be required to understand denials, denial trends, or any other issues preventing payment, employee will take the appropriate steps needed to resolve the account. The Senior Accounts Receivable Specialist will work in conjunction with RCM Manager/Director to identify coding and other billing error trends. The Senior Accounts Receivable Specialist utilizes a variety of proprietary and external tools to research and resolve insurance claims. The Senior Accounts Receivable Specialist will be required to contact insurance companies via phone or website. Essential Duties and Responsibilities Performs all duties and responsibilities in accordance with local, state, and federal regulations and company policies. Utilize and apply industry knowledge to resolve new and aged accounts receivables by working complex in nature account denials, projects, and rejections including but not limited to professional claims, governmental and/or non-governmental claims, denied claims, aged accounts, high priority accounts, high dollar accounts, reimbursements, credits, etc. Leverage available resources and systems (both internal and external) to analyze patient accounting information and take appropriate action for payment resolutions, document all activity in accordance with organizational and client policies. Communicate professionally (in all forms) with payer resources to include websites/payer portals, e- mail, telephone, customer service departments, etc. Maintain quality and productivity results at a level that meets departmental standards as measured by a daily/weekly/monthly average. Research, trends, and resolves claims of a complex nature Understands remit and remark codes and demonstrates knowledge of resolving complex claim denials Escalates difficult/problem claims with predetermined next steps Reviews and resolves high dollar and/or highly complex outstanding insurance receivables Reviews claims data and supporting documentation to identify coding and/or billing concerns. Ability to interpret payer contracts and identify contract variances affecting reimbursement. Utilize knowledge of the cash posting processing to obtain the necessary information to resolve misapplied payments. Demonstrate clear proficiency in third-party billing requirements to include federal, state, and commercial/managed care payers. Interpret claim scrubber edits/rejections and takes appropriate action necessary to resolve issues. Seek resolution to problematic accounts and payment discrepancies. Prepare appeal letters for technical denials by accessing specific payer appeal forms, submitting appropriate medical documentation and tracking appeal resolution.
Works with projects and groups to develop or change existing revenue cycle processes to accommodate changes in business model Analyze accounts with critical thinking; consider payer contracts and billing guidelines to ensure one- touch resolution. Further responsibilities may include reviewing insurance credit balances to determine root cause and take the steps necessary to resolve the account. Serve as a resource to other team members and assist Team Leads with identifying A/R and denials trends. Other Duties as Assigned. Qualification Requirements : To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Position requires constant mental alertness, attention to detail, and high degree of accuracy required in completing all assignments. Strong problem-solving skills. Smart, driven, exceptional work ethic. Must be able to follow oral and written instructions and follow -through on all assignments. Excellent organizational skills. Highly detailed-oriented. Ability to work well in a group setting and independently.
Education and/or Experience : High school diploma or equivalent. Preferred 4+ years medical billing and Accounts Receivable - in a physician office setting. General knowledge of HCPCS and CPT coding. Working knowledge of practice management software and various payor portals Working knowledge with allowable/contractual amounts, payment terminology, adjustments, identifying patient responsibility. Language Skills : Ability to read, analyze, and interpret human service periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. Excellent communication and interpersonal skills.
Mathematical Skills : Ability to calculate figures and amounts such as percentages, mean, mode and median ability to draw and interpret graphs.
Reasoning Ability : Ability to define problems, collect data, establish facts, and draw valid conclusions.
Physical Demands : The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made
to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
The employee occasionally lifts/carries paperwork, files, office supplies, up to 20 lbs., pushes/pulls exerting up to 5-10 lbs. force, opening doors, file drawers, pushing files in drawers, and kneeling/crouching and/or ability to reach lower file drawers, file stretching to store of retrieve materials. Specific vision abilities required by this job include close vision and the ability to adjust focus. Frequent sitting at desk or computer while typing, completing paperwork, or meeting with patients.
Work Environment : The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
Normal office environment where there is no physical discomfort cue to temperature, dust, noise, and the like. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
