FLSA Status

Job Role Summary

The Accounts Receivable Specialist may be responsible for maintaining the life of a claim which may include the following: Initiate Billing, Charge Entry, Claim Edit, DNB, Stop Bills, Claim Rejection, Denial, Follow-up, No Response, Variance, Correspondence and Credit Balance Resolution. The Accounts Receivable Specialist communicates with the insurance carriers to ensure appropriate and compliant payment of services via: telephone, email, fax, payor website. This position reviews reports to determine trends and discusses with management to help resolve front-end errors, reviews and follows up on all claims not paid by carriers in a timely manner and claims not paid appropriately.

Essential Functions and Responsibilities

• Proactively contributes to Eskenazi Health’s mission: Advocate, Care, Teach and Serve with special emphasis on the vulnerable population of Marion County. Models Eskenazi Health values of Professionalism, Respect, Innovation, Development and Excellence.
• Assist customer service with follows up on patient calls within a timely manner
• Maintains department weekly production and monthly quality measures
• Communicates effectively and appropriately with internal and external customers
• Acts independently seeking guidance when necessary to remain compliant with federal, state, and hospital policies relative to insurance patient billing
• Initiates proper course of action for problem solving resolution
• Analyzes all claim denials to determine the best course of action to resolve any issue and receive appropriate payment
• Verifies and updates claims with insurance and demographic information when changes are needed
• Resolves inquiries from internal and external customers
• Takes active role in special projects as requested
• Gathers and distributes insurance information obtained through verbal and/or written communication for the purpose of maintaining sufficient cash flow
• Analyzes and resolves issues reported from the self-pay outsource vendor
• Utilizes interpersonal communication strategies/skills to achieve desired outcome/results with patients/families and others
• Provides coverage for co-workers as necessary due to PTO/illness
• Continues knowledge based learning on payor guidelines and requirements for appropriate billing
• Enter daily charges for NTP clinic
• Works charge review in a timely and accurate manner to ensure appropriate billing of services
• Resolves claim edits, rejections (internal/external), DNB, Stop Bills, follow up, variance, denials, credit balance resolution and correspondence
• Initiate Billing/Charge Review resolution

Job Requirements

• Associate Degree in business-related field or technical training in coding and/or billing in lieu of
• Three years of experience in medical practice/hospital setting with billing, insurance follow-up and/or credit balance experience.
• CPC Certification a plus
• Dental, Vision, Behavioral Health and/or DME experience a plus

Knowledge, Skills & Abilities

Pays close attention to detail with accuracy in record keeping and documentation
Identifies trends with denials (providers/locations/carriers) and works with management to help educate or resolve errors from the start and avoid back-end denials
Willingness and ability to assist other team members
Excellent problem-solving skills and ability to cooperate with others
Works independently and efficiently
Working knowledge of Microsoft Office Software, Windows
Utilizes calculator, printers, copiers, and fax machines
Strong math skills
Strong organizational skills and ability to work efficiently in a high volume, multi-task environment meeting deadlines
Uses professional and appropriate communication skills
Advanced understanding of health insurance medical policy and billing requirements, including government and managed care programs as well as traditional Medicaid, Medicare replacement plans, commercial carriers, HIP, Anthem
Ability to meet production and accuracy requirements outlined by department goals