RCM AR Specialist

Accounts ReceivableAccounts ReceivableOtherRemoteMid LevelTeam 1,001-5,000

Location

United States

Posted

7 days ago

Salary

0

Seniority

Mid Level

No structured requirement data.

Job Description

RCM AR Specialist

ALLERGY PARTNERS

Role Description The RCM AR Specialist follows up on Claim Denials and overdue insurance balances using Explanation of Benefits (EOB) documents and reports. They are assigned a specific book of business based on Financial Class and Payers, working to support the field related to claim denials. Responsibilities Include, But Are Not Limited To, The Following: Daily Duties - Follows up on denied claims and no response within a timely manner. - Submits appeals related to contract rate variances with a discrepancy in allowed amounts; notifies Supervisor of payers for which this is a consistent problem. - Submits Medical Records when requested by the payer for claims processing determination. - Monitors and reviews Payer correspondence from the lockbox and faxes. - Monitors, reviews, and responds to Hub (field) communication inquiries within the 48-hour requirement. Account Follow-Up - Using data from the monthly aged accounts receivable report, calls payers or looks up claims status online to inquire about unpaid insurance claims that are 45 days old; records response or activity in the computer system “notes”. - Maintains detailed knowledge of practice management and other computer software as it relates to job functions. - Responds to written and telephone inquiries from insurance companies. - Builds and maintains relationships with personnel from assigned carriers. - Meets with Pod Lead/Supervisor regularly to discuss and solve reimbursement and insurance follow-up concerns. Other - Maintains detailed knowledge of practice management and other computer software as it relates to job functions. - Attends all meetings as requested including regular staff meetings. - Attends Medicare and other continuing education courses as requested. Pursues and participates in education to remain current with changes in the Healthcare industry. - Performs any additional duties as requested by RCM Leadership. - Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes. - Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP EthicsPoint hotline. - Models the AP Code of Conduct and demonstrates a commitment to the AP Compliance Program, standards, and policies. Qualifications - High school diploma or GED equivalent, required. - College education or trade school preferred. - Previous Medical Billing and Collections experience preferred. Preference for those with a minimum of eighteen months experience. - Comfortable using email and interacting with Internet applications. - Knowledge of practice management and Microsoft processing software. - Proven understanding of Explanation of Benefits forms, claim forms, and the insurance billing process. - Working knowledge of managed care, commercial insurance, Medicare, and Medicaid reimbursement. - Basic knowledge of CPT and ICD-10 coding. - Strong written and verbal communication skills. Requirements - Physical demands are moderate with occasional lifting of items weighing approximately 20-30 pounds. - Position requires prolonged sitting, some bending, stooping, and stretching. - Good eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment is also required. - Employee must have normal range of hearing and vision must be correctable to normal range to record, prepare, and communicate appropriate reports. - Working conditions are a professional office environment. If remote, must have functioning internet and be open to on-camera team calls. - Occasional evening or weekend work. Benefits - The salary range posted for this position is the national average; however, actual compensation may vary depending on geographic location, job-related knowledge, skills, and experience.

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