Accounts Receivable Specialist III #Full Time - 61st Street Service Corp

Top Healthcare Provider Network

Join our team of highly skilled clinical and administrative healthcare professionals who support our mission to help facilitate the deliver of world-class, patient-centered care by one of the top healthcare provider networks.

Job Summary:

The Accounts Receivable Follow-Up and Claim Edits Specialist III is responsible for reviewing and performing appropriate actions on charges and claims. This position is the point person within the department responsible for making all charge and claim corrections. Responsibilities include, reviewing charge, claim, and patient registration edits, follow-up work to collect on all open and unpaid accounts with insurance companies and third parties, initiating appeals for claims denied for coding, and contacting patients, or account guarantor. This position must exhibit professional and courteous behavior at all times during communications. The Account Receivable Follow-Up and Claim Edits Specialist III is part of a team that works to review, evaluate, and improve the clinical denial and appeal process.

Job Responsibilities:

• Researches root issue of denial. Pursue proper course of appeal or follow up to obtain payment.
• Reviews account history for continuous follow up.
• Addresses incoming correspondence and respond timely to ensure prompt resolution. Prepares correspondence to insurance companies, patient and/or guarantor, as necessary.
• Contacts insurance companies and/or patient/guarantor through phone contact, correspondence, online portals and other approved means to obtain status of outstanding claims and submitted appeals.
• Documents clearly in billing system the claim issue and course of action taken on every account worked.
• Escalates issues and problems to Supervisor as appropriate.
• Performs charge corrections based on payer and institutional policies.
• Performs demographic and insurance coverage updates on account as appropriate and bill new insurance as appropriate.
• Performs other job duties as required and assigned.
• Serves as a first point of escalation for complex cases or issues. Applies organizational knowledge, experience, and critical thinking skills to determine resolution and/or escalate as appropriate. Ensures resolution is executed.
• Assists with educational sessions to train new staff in front-end process in an efficient and effective manner to insure processes, functions and goals are understood and met. Mentors Level I and Level II staff.
• Resolves escalated cases. Escalates issue for resolution if and when appropriate. Tracks and follows through for complete resolution. Makes recommendation to update/revise procedure or workflow as needed.
• Helps identify solutions and takes ownership for resolving conflicts. Communicates with management team and care providers to resolve issues. Collaborates with all co-workers and follows up as appropriate regarding reported complaints, problems and concerns.
• May assist Supervisor/Manager with special projects as needed.

Job Qualifications:

• High school graduate or GED certificate is required.
• A minimum of 3 years’ experience in a physician billing or third party payor environment.
• Candidate must demonstrate a strong customer service and patient focused orientation and the ability to understand and communicate insurance benefits explanations, exclusions, denials, and payer claim and appeal forms.
• Candidate must demonstrate advanced proficiency in medical terminology, diagnosis and procedure coding.
• Must demonstrate effective communication skills both verbally and written.
• Ability to multi-task, prioritize, and manage time effectively.
• Intermediate to advanced proficiency in computer software skills (e.g. Microsoft Word, Excel and Outlook, E-mail, etc.)
• Ability to mentor teammates and demonstrate professional and compassionate manner while conveying a positive image of the organization. Encourages positivity and adaptability to new and changing situations.
• Candidate must be well organized and be able to manage a demanding workload and help other Specialists with a wide range of complex cases and special cases in an accurate and timely manner.
• Strong organizational and problem solving skills, and the ability to set priorities among multiple competing objectives, tasks and initiatives is required.
• Experience in Epic and or other of electronic billing systems is preferred.
• Previous experience in OB/GYN is preferred.

Hourly Rate Ranges: $27.40 - $36.06

Note: Our salary offers will fall within these ranges based on a variety of factors, including but not limited to experience, skill set, training and education.

61st Street Service Corporation

At 61st Street Service Corporation we are committed to providing our client with excellent customer service while maintaining a productive environment for all employees. The Service Corporation offers a competitive comprehensive Benefit package to eligible employees; including Healthcare and various other benefits including Paid Time off to promote a healthy lifestyle.

We are an equal employment opportunity employer and we adhere to all requirements of all applicable federal, state, and local civil rights laws.