Why Holy Redeemer?
At Holy Redeemer, you will experience:
- A culture that inspires and motivates team members to provide a highly personalized experience for patients, residents, clients, families, volunteers, partners and co-workers.
- Dedication to established safety practices and standards to maintain a safe environment for all.
- Competitive salary and outstanding benefits, including a 403B matching retirement program and comprehensive orientation and training programs.
- A commitment to employee health and well-being with our Healthy U! Program's health and wellness activities, and opportunities aimed at stress reduction, balanced nutrition, physical activity, and preventive health behaviors.
- A collaborative work environment where all employees are comfortable sharing knowledge about situations, raising concerns and asking questions.
SUMMARY OF JOB:
The Account Receivable Specialist is responsible for performing resolution oriented claims submission and follow-up to achieve cash recovery and A/R resolution goals of assigned health system receivables, through established methods and procedures using current available technology. Receives and responds to inquiries from third-party carriers and patients, processes correspondence and documents all work activity in electronic patient files. Responsible to meet daily/weekly productivity and quality reasonable work expectations. Collaborates with Health System departments to achieve the HRHS CBO key performance metric targets established by Senior Leadership
- S. diploma/GED,
- 3-5 years experience in medical billing or healthcare accounts receivable experience; medical billing coursework may be substituted for prior experience.
- Knowledge of third party payer contracting language and reimbursement terms.
- Knowledge of medical terminology, ICD10, CPT, and HCPC coding
- Familiar with multiple (widely used) healthcare patient accounting/billing systems.
- Proficiency with Excel, MS Office, Internet Explorer, and Database Management application software.
- Ability to communicate in English, both written and verbal. Additional languages are preferred.
- Ability to handle multiple tasks and accurately process high volumes of work
- Ability to establish and maintain effective working relationships with patients, employees and the public
- Strong organizational and time management skills.
- Good analytical skills, assertive in resolving unpaid claims.
- Ability to work independently, with minimal supervision.
- Responsible for the resolution of unpaid claims on a timely basis. Responsible to achieve cash recovery and A/R resolution goals and CBO quality and productivity guidelines. Provides feedback to management regarding any issues or repetitive errors that may be encountered during claim review and submission. Ensures compliance with all state and federal billing regulations and reports suspected compliance issues to Manager.
- Reviews system generated work list, reports and/or aged trial balances to resolve accounts which have not been paid in the appropriate time frame, based on specific third party payor contracts and guidelines. Documents account activity in an accurate and timely manner on all patient accounts.
- Contacts payer representatives to review outstanding unpaid claims for payment. Obtains and supplies any missing information required to adjudicate claims. Attends meetings with payer representatives and/or vendors to address outstanding issues.
- Reviews payment denials and discrepancies identified through payer EOB’s, remittance advices or correspondence and takes appropriate action to correct accounts.
- Applies a high level of knowledge of respective insurance billing regulations and guidelines. Researches guidelines when required on the payer websites
- Conduct inquiries via telephone, mail, and fax or electronically through payer website or e-mail for follow-up of those unresolved accounts.
- Contacts patient, if needed, for additional information in order to have claims processed and paid.
- Collaborates with various Hospital departments to obtain additional information for the billing and follow-up process.
- Review and process all insurance and patient refunds
- Collaborates with Management and CBO staff to improve processes, increase accuracy, create efficiencies and achieve overall goals of the department. Demonstrates efficient and effective use of organizational resources as well as systems and services.
- Maintains proficiency and level of knowledge with all systems required for task completion.
- Annually attends at least three healthcare related training or seminars to remain current with insurance updates, requirements and changes in payment patterns or processes