Accounts Receivable Specialist – RCM
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Job Description
Accounts Receivable Specialist for US Anesthesia Partners working on claims and denials. Collaborating with various payers and supporting AR processes with a focus on efficiency.
Responsibilities:
- Performs advanced level work related to denial management
- Processes and follows up on all appeal types, at an expert level, to all payers
- Takes actionable steps to resolve open claims, as needed, including refiling or appealing claims, or resolving manual tasks assigned to AR for review
- Works outstanding accounts receivable from assigned projects
- Functions as an SME across multiple workflows and various payers
- Provides peer payer and system training support
- Identifies denial patterns and escalates to management for follow-up and/or root cause resolution
- Makes recommendations to work queues and claim edits to improve efficiency and reduce denials
- Reviews payer communications related to changes in medical and reimbursement policies
- Researches payer trends identified by offshore partners to recommend training/process improvement
- Identifies opportunities for and actively participates in process improvement initiatives
- Maintains strictest confidentiality
- Maintains basic proficiency with using spreadsheets
- Maintains productivity and quality standards established by RCM
- All other duties as assigned
Requirements:
- High school graduate or equivalent
- Associate or bachelor’s degree in business administration or related field of study preferred
- Minimum of 3 years accounts receivable experience preferred
- Excellent verbal and written skills to maintain professionalism in all methods of communication
- Basic math skills for calculating anesthesia units, proper reimbursement, and percentages for appropriate adjustments
- General understanding of medical terminology
- Advanced knowledge of insurance processing, payer policies, guidelines, and explanation of benefits (EOB’s)
- Knowledge of commercial payer, Medicare, and Medicaid guidelines
- Data entry skills with high accuracy
- General knowledge and understanding of CPT, ICD-10, and ASA codes
- Good problem-solving skills
- Decision making ability with sound judgment
- Strong analytical skills and attention to detail, including gathering and aggregating information
- Ability to work effectively with all team members, including physicians and external vendors or patients
- Must be able to work in a virtual team environment
- Ability to work independently with limited supervision
- Computer application skills to include MS Word, MS Excel, MS Outlook, and MS Teams
Benefits:
- Eligible for a quarterly bonus
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