AR Billing/IDR Arbitration Specialist - FTP Billing

General Summary

This position oversees the functions of medical billing, coding, and arbitration processes in compliance with the No Surprises Act (NSA) and related healthcare regulations. This role ensures maximization of cash flow through detailed claims handling and issue resolution, while enhancing patient, physician, and other customer relations. Critical thinking, data analysis, and report presentation skills are essential. Daily coordination with insurance carriers is required, including negotiations and reconciliation of claims through the Independent Dispute Resolution (IDR) process as mandated by NSA.

Essential Job Responsibilities

• Act as the practice expert for coding, billing, and compliance processes, including the NSA guidelines.
• Oversee patient insurance documentation, coding accuracy, billing and collections, and data processing for effective account management.
• Analyze and submit claims, ensuring accuracy and completeness per NSA guidelines; resolve any claim discrepancies.
• Monitor claims using various systems, ensuring timely and compliant processing.
• Manage the IDR, Arbitration, and Informal Teleconference processes as part of NSA-related claims.
• Collaborate with other departments to gather and analyze patient information, supporting accurate billing documentation.
• Prepare and analyze accounts receivable and financial reports with the Director of Operations; maintain comprehensive insurance contract documentation.
• Audit billing and collection procedures to ensure regulatory compliance and operational efficiency.
• Ensure billing operations align with Federal, State, and payer-specific regulations, with an emphasis on NSA compliance.
• Participate in the development and implementation of operational policies and procedures, with adjustments based on NSA requirements.
• Review operational data, identify trends in billing and collections, and recommend improvements for increased revenue and efficiency.
• Update the team on regulatory changes, including NSA-related updates and carrier rule modifications.
• Oversee physician credentialing processes, ensuring compliance with NSA and billing standards.
• Maintain current knowledge of billing regulations, coding guidelines, and compliance requirements, specifically focusing on NSA provisions.
• Maintain health information management standards, including HIPAA compliance.
• Supervise and train billing staff, ensuring adherence to NSA-related policies, procedures, and best practices.
• Coordinate staff schedules to maintain essential daily functions and avoid disruptions.
• Perform other relevant duties as assigned.

Knowledge, Skills, Abilities

• Expertise in Medical Billing & Coding: Strong understanding of medical billing, collections, revenue cycle management, and NSA compliance.
• Regulatory Knowledge: Proficient with NSA, HIPAA, CPT, ICD-10 codes, HCFA 1500, UB04 claim forms, and billing/insurance regulations.
• Negotiation Skills: Skilled in payment negotiations, including arbitration as specified under the NSA.
• Healthcare Business Acumen: Knowledge of basic accounting, business management principles, and payer regulations.
• Communication & Interpersonal Skills: Effective communicator with physicians, patients, insurers, and colleagues.
• Proficiency in Microsoft Office: Particularly skilled in Outlook, Word, and Excel for data analysis and reporting.
• Independent and Initiative-Driven: Ability to work with minimal supervision, make sound decisions, and demonstrate proactive problem-solving skills.
• Analytical Ability: Skilled in evaluating workflows, identifying solutions, and implementing improvements in compliance with NSA standards.
• Supervisory Skills: Ability to train, organize, and motivate staff effectively.

Required Education and Experience

• Certified Coder (Preferred)
• TDI & Arbitration Experience: Minimum one (1) year experience with Texas Department of Insurance (TDI) and arbitration processes, particularly those related to NSA.
• Billing/Collections Experience: Minimum two (2) years in medical billing and collections, including knowledge of NSA-related regulations.
• Emergency Department & Urgent Care Billing: At least two (2) years of experience with ED and Urgent Care billing/coding. Free-standing ER billing experience strongly preferred.
• Electronic Medical Record Systems: Prior experience required.

Working Conditions

Standard office equipment (computers, fax machines, copiers, etc.) in a well-lit office environment. Occasional evening and weekend work may be required to meet deadlines and ensure NSA compliance. This is not a remote position.