Account Receivable/Denials Management Specialist

  • ProCare Pain Solutions
  • Remote
  • Nov 11, 2020
Full time Admin-Clerical

Job Description

The Account Receivable/Denials Management Specialist functions in an administrative role to ensure timely and accurate follow-up on unpaid claims and denials.  This position is responsible for  following up on all outstanding accounts which includes reviewing outstanding A/R reports, outstanding accounts in follow-up queues and identifying and reporting trends and changes in payments and denials.  The account receivable specialist works under the direction of and reports to the billing team leader.

 

 

Requirements:

 

 

Education:

 

Minimum:    High School graduate.  Working knowledge of medical terminology as well as procedural and diagnosis coding is required.

 

Preferred:     Higher education with a medical office or account focus. Certified Professional Coder (CPC), Certified Professional Biller (CPB) or Certified Revenue Cycle Specialist-Professional (CRCS-P) preferred

 

Work Experience:

 

Minimum:     One year of recent, relevant experience with accounts receivable follow-up and/or denials management experience.

 

Preferred:     Two or more years of recent, relevant experience with accounts receivable follow-up and/or denials management experience; experience with working in eClinical Works or Centricity preferred.

 

Professional Skills:

 

Communication:    Effective verbal and written skills, computer literate

 

Customer Service:    Patient confidentiality, helpful, patience

 

Organizational:    Detail oriented, problem solving abilities, efficient

 

Team Skills:    Demonstrate ability and willingness to work as an effective part of a team

 

CHARACTERISTIC DUTIES AND RESPONSIBILITIES:

 

Account Follow-Up and Denials Management Skills:

Effectively manage accounts receivable within area of assignment

Use aging reports, work queues, tasks, ticklers and other follow-up techniques to ensure timely follow-up of unpaid claims and timely follow-up on claims that have been underpaid or denied

Use payer websites, payer inquiry methods, payer representatives and other applicable payer specific methods to obtain prompt payment of claims and identification and resolution of any issues affecting prompt payment

Write and follow-up on appeal letters for denied claims referencing any applicable research, medical record documentation, medical policy and/or coding and billing rules

Maintain a working knowledge of 835 and 277 rejection and denials reason codes (Remittance Advice Remark Codes (RARC) and Claim Adjustment Reason Codes (CARC)) along with payer specific adjustment and denial codes.

Demonstrate ability to follow internal policies and procedures regarding follow-up timelines and methods, documentation standards and spreadsheet creation and maintenance as assigned

 

Administrative Skills:

Handle incoming and outgoing correspondence

Provide telephone support for patients and insurance carriers

Communicate with others on team including cash posters and  leadership regarding payers not meeting contractual obligations pertaining to timely payment, denials and any trends or outliers noted

Communicate with on-site clinic staff regarding medical documentation needs

 

Quality Management

Adhere to corporate compliance and HIPAA standards and policies

Use relevant knowledge of carrier issues, medical policies and billing standards to ensure accurate and timely payments (know when to question)

Participate in peer review, quality management and outcome studies as assigned

Follow standards, policies and procedures to make appropriate adjustments

 

PHYSICAL DEMANDS:

Independently mobile to perform job tasks

Approximately 99% of time sent sitting

Moderate to heavy computer use

Able to lift up to 30 pounds

 

ACCIDENT AND HEALTH HAZARDS:

COVID-19 Risk Level Assessment = Low

Potential exposure to communicable pathogens

 

WORKING CONDITIONS:

Fast paced, demanding office environment

Exposure to a variety of attitudes and personalities from patients and visitors

Multiple interruptions