Accounts Receivable Escalation Specialist
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Job Description
Accounts receivable escalation specialist resolving denied claims, appeals, and insurance billing issues. Supporting Ventra Health’s revenue cycle management services for healthcare providers.
Responsibilities:
- Analyze collections, resolve non-payables, and handle complex bill inquiries
- Follow up on claim rejections and denials to ensure appropriate reimbursement
- Process assigned accounts receivable work lists in a timely manner
- Write and process appeals for claim denials
- Identify and resolve denied, non-paid, and non-adjudicated claims and billing issues
- Recommend accounts for write-off through Adjustment Requests
- Report address and filing rule changes to the manager
- Check systems for missing payments
- Properly notate patient accounts
- Review correspondence and determine specific problems
- Research patient accounts and determine appropriate follow-up actions
- Scan correspondence and index it to the proper account
- Make inbound and outbound follow-up calls as required
- Respond to and communicate with insurance companies regarding outstanding claims
- Meet established production and quality standards
- Perform special projects and other assigned duties
Requirements:
- High School Diploma or GED
- At least one (1) year in the data entry field and one (1) year in medical billing and claims resolution preferred
- AAHAM and/or HFMA certification preferred
- Experience with offshore engagement and collaboration desired
- Intermediate knowledge of medical billing rules, including coordination of benefits, modifiers, Medicare, and Medicaid, and understanding of EOBs
- Become proficient in billing software within 5 weeks and maintain proficiency
- Ability to read, understand, and apply state/federal laws, regulations, and policies
- Ability to communicate with diverse personalities in a tactful, mature, and professional manner
- Ability to remain flexible and work within a collaborative and fast-paced environment
- Basic use of a computer, telephone, internet, copier, fax, and scanner
- Basic touch 10 key skills
- Basic math skills
- Understand and comply with company policies and procedures
- Strong oral, written, and interpersonal communication skills
- Strong time management and organizational skills
- Strong knowledge of Outlook, Word, Excel (pivot tables), and database software
Benefits:
- Ventra performance-based incentive plan
- Referral bonus
- Discretionary incentive bonus in accordance with company policies
- Reasonable accommodations for qualified individuals with disabilities, as needed
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