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.
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
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.
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
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
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
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
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
Fast paced, demanding office environment
Exposure to a variety of attitudes and personalities from patients and visitors
An innovator in today’s rapidly changing healthcare environment, ProCare Pain Solutions, a NAPA company, provides healthcare institutions and physician practices with the strategies, systems and tools needed to increase productivity, reduce costs and maximize organizational value. Originally created in 1994 to service the management needs of ProCare Co-Founders Drs. Fred Davis and Mark Gostine’s clinical practice, Michigan Pain Consultants, PC, ProCare began and continues to build on the foundation of helping local practices connect with their surrounding communities and deliver exceptional patient care.
In 2016, ProCare joined North American Partners in Anesthesia (NAPA), one of the leading single-specialty anesthesia and perioperative management companies in the US, to expand the organization’s efforts on helping patients across the nation manage and alleviate acute and chronic pain through a data-driven patient experience system.