A/R Specialist Level II

ID
2017-17503
Department
Patient Accounting
Work Hours
0800-1630
Position Type
Regular Full-Time
Hours Per 2-Week Pay Period
80 Hours
US-NY-Plattsburgh
Weekend Requirements
Weekends and holidays as scheduled

Overview

If you would like more information or have questions, please contact Katrina Stone, Recruiter.

 

 

The billing and customer service representative processes charge and/or payment information, enters into database, completes billing process, and assists with daily reconciliation. Responsible for billing and collecting inpatient and outpatient Hospital and physician billing accounts according to established policy and procedure. In addition, is responsible for accurately maintaining account balances on a daily basis, as well as staying current with constantly changing rules and regulations in order to ensure prompt collection of monies due. Must maintain files for accurate follow-up on unpaid accounts.

Responsibilities

ESSENTIAL FUNCTIONS:         HOSPITAL TRACK

Bills patients and third party insurances in compliance with applicable regulations and contractual agreements.

  1. Demonstrates thorough understanding of patient accounting and electronic billing information systems.
  2. Responsible for communicating any software, insurer or procedure issue to the appropriate party.
  3. Responsible for seeing that everything which is available to be billed on a daily basis is billed within 48 hours (with the exception of series accounts which are to be billed as soon as possible). This includes newly billable accounts, secondary bills and other transfers and rebills.
  4. Responsible for reading current contract, online or paper provider manuals and monthly bulletins for assigned insurance line. Demonstrates a thorough understanding of all applicable insurance regulations and contractual requirements as it applies to billing and collecting accounts receivable.
  5. Responsible for communicating any significant billing or insurance issue to the manager in a timely manner.
  6. Verifies that accurate and complete information is included on the claim form in accordance with specific payor requirements.
  7. Responsible for communicating any significant registration, charge entry or coding issues which may be identified to the manager in a timely manner.

Adjust charges on accounts when appropriate

  1. Works late charge reports on a daily basis.
  2. Researches the legitimacy of late charges and posts to the appropriate account; correcting insurance and patient balances as required.
  3. Credits charges on accounts only if proper authorization is provided to substantiate the credit adjustment.
  4. For charges which have been inadvertently posted to the improper account, locate the correct account and adjust charges as needed.
  5. Resubmit bills for adjusted accounts.

Processes insurance rejections, denials or requests for additional information in a timely manner

  1. Responsible for changing financial class, transferring balances to other insurance or patient and documenting account for all appropriate rejections.
  2. Responsible for providing Utilization Review and/or Medical Records with any relevant denial information or correspondence.
  3. Responsible for following up with patient or insurance company or providing missing information for questionable rejections and submitting rebills as needed.
  4. Files appeals to insurance company for any denial reason we don’t accept as valid. May also include working with the patient to assist in resolving claim.
  5. Obtain example of denials for project rework or presentation at provider meetings.

Processes payment remittance including calculating contractual allowances and verifying accuracy of payments in a timely manner.

  1. Responsible for calculating contractual allowances and verifying accuracy of payments in accordance with the terms of individual insurance contracts
  2. If payment is correct, responsible for changing the financial class, transferring balances appropriately and documenting the nature of the remaining balance.
  3. If payment is incorrect, responsible for following up with insurance company to assure complete payments are received.

Demonstrates accountability for assigned accounts

  1. Identifies all accounts which have been billed and for which there is still an open balance and follows up with rebilling or otherwise communicating with insurance companies and/or patients as appropriate.
  2. Communicates any unusual or significant insurance issues to manager in a timely manner.
  3. Communicates any unusual issues affecting workload to manager in a timely manner and is able to communicate the status of workload including backlogs and the reasons why backlogs exist. Is also able to develop and implement a plan for elimination of workload backlogs.

Courteously handles incoming phone calls; answering questions, providing information and recording billed related information as appropriate.

  1. Answers phone courteously and promptly.
  2. Answers inquiries from patients and insurance companies. Educates patients with regards to billing and insurance requirements whenever possible.
  3. Records patient concerns that cannot be answered by a biller to forward to the appropriate party; makes patient aware of the fact that the concern will be investigated and who they may expect to receive a response from.
  4. Updates accounts with any additional or corrected information obtained from patients or insurances.
  5. Documents nature of conversation on account when appropriate, including all relevant details.
  6. Refers phone calls to appropriate party if unable to answer or satisfy caller
  7. Obtains credit card information and sends through proper channels for processing and posting payment to the account(s).
  8. Other duties as assigned.

Training, policy and procedure development, coordinate and implement new processes, assist other employees, attend training sessions associated with assigned insurance lines.

  1. Assist new and existing employees with current workload, as necessary.
  2. Cross-train in multiple insurance lines and categories of patient.
  3. Assist management to coordinate and implement new processes.
  4. Identify opportunities for increased revenue.

Contract/provider handbook knowledge, denial management, troubleshooting, provider representative relations, payer projects and analysis, a/r dashboard

  1. Receive new provider manual updates and monthly bulletins. Route information to all responsible parties and file.
  2. Produce summary document from monthly bulletin or provider manual update to present at work group meeting.
  3. Prepare quick reference tools related to contracts/manuals for other employees/management.

 

ESSENTIAL FUNCTIONS:         PHYSICIAN TRACK

 

  1. Bills patients and third party insurances in compliance with applicable regulations and contractual agreements.
  2. Adjusts charges on accounts when appropriate.
  3. Processes insurance rejections, denials, or requests for additional information in a timely manner.
  4. Processes payment remittances including calculating contractual allowances and verifying accuracy of payments in a timely manner
  5. Demonstrates accountability for assigned accounts by working the aged trial balance.
  6. Courteously handles incoming phone calls, answering questions, providing information and recording billing-related information as appropriate.
  7. Ensures refunds are made to insurance companies/Patients on all overpayments when received.
  8. Accurately reviews the data received for billing including CPT codes, ICD-9 codes, physicians, modifiers, and location codes.
  9. Continuously works/runs reports for aging and unpaide claims in a timely fashion.
  10. Responsible for communicating any software, insurer or procedure issue to the appropriate party.
  11. Responsible for reading current contract, online or paper provider manuals and monthly bulletins for assigned insurance line. Demonstrates a thorough understanding of all applicable insurance regulations and contractual requirements as it applies to billing and collecting accounts receivable.
  12. Responsible for communicating any significant billing or insurance issue to the manager in a timely manner.
  13. Responsible for reading patient care reports to accurately code for ambulance billing.
  14. Other duties as assigned.

Training, policy and procedure development, coordinate and implement new processes, assist front end office employees, attend training sessions associated with medical specialty

  1. Train new and existing front-end office employees.
  2. Perform new physician compliance training and perform quarterly E&M audits.
  3. Assist management to develop efficient workflows for physician referrals, authorizations, billing and collections.
  4. Assist management to coordinate and implement new processes.
  5. Attend training courses related to medical specialty.
  6. Identify opportunities for increased revenue.

Contract/provider handbook knowledge, denial management, troubleshooting, provider representative relations, payer projects and analysis, a/r dashboard

  1. Cross-train in multiple insurance lines and categories of patient.
  2. Receive new provider manual updates and monthly bulletins. Route information to all responsible parties and file
  3. Produce summary document from monthly bulletin or provider manual update to present at work group meeting
  4. Prepare quick reference tools related to contracts/manuals for other employees/management.
  5. Produce reports as necessary for management and related departments.

 

ESSENTIAL FUNCTIONS:         CUSTOMER SERVICE TRACK

Establishes and Monitors Pay Arrangements on Patient Accounts and Performs other related collection and credit review activities.

  1. Demonstrates a thorough understanding of the patient accounting system including the specific patient statement types and cycles.
  2. Establishes reasonable payment arrangements with patients in accordance with policy and documents accounts appropriately.
  3. Monitors compliance with payment arrangements and investigates reasons for and makes recommendations with regards to delinquencies.
  4. Assists patients to the extent possible with regards to insurance or billing related issues which may be affecting their willingness to make timely payments.
  5. Provides guidance to under or uninsured patients who do not feel that they can afford to pay their bills by encouraging them to first apply for Medical Assistance and then they apply for our financial assistance program if appropriate.
  6. Follows up with patients who are awaiting Medicaid eligibility determination.
  7. Processes patient requests for itemized statements in a timely manner.
  8. Responsible for communicating any unusual system or statement related issues to manager. 
  9. Review financial assistance applications to determine if the patient is eligible for full or partial assistance and notifies the patient of the determination in a timely manner.

Facilitates Externally administered precollection and collection activities.

  1. Reviews precollection and collection agency prelist reports and removes or holds accounts as appropriate.
  2. Reviews accounts which may not be “automatically” selected for pre-collection or collection and manually refers accounts as appropriate.
  3. Documents notifications of bankruptcies, deaths, etc. in the patient accounting system and notifies collection agency in a timely manner so that appropriate actions may be taken.  
  4. Demonstrates a thorough understanding of how patient accounting system transfers information to precollection and collection agencies and how this affects the patient accounts within the patient accounting system. 
  5. Notifies Manager of any unusual activity as it relates to precollection or collection activities or data.

Demonstrates accountability for assigned accounts.

  1. Demonstrates appropriate collection efforts.
  2. Processes account adjustments and allowances only if properly authorized.
  3. Communicates any unusual or significant patient related issues to manager in a timely manner.  
  4. Communicates any unusual issues affecting workload to manager in a timely manner and is able to communicate the status of workload including backlogs and the reasons why backlogs exist. 
  5. Periodically follows up on all patient balances which are being held due to patient concerns or for other reasons and notifies manager of any unusual circumstances which may delay resolution of the account unreasonably.

Courteously handles incoming phone calls; Answering questions, providing information and recording billing related information as appropriate.

  1. Answers phones courteously and promptly.
  2. Answers inquiries from patients and insurance companies. Educates patients with regards to billing and insurance requirements whenever possible.
  3. Records patient concerns that cannot be answered by yourself to forward to the appropriate party; makes patient aware of the fact that the concern will be investigated and who they may expect to receive a response from.
  4. Updates accounts with any additional or corrected information from patients or insurances.
  5. Documents nature of conversation on account when appropriate, including all relevant details.
  6. Refers phone calls to appropriate party if unable to answer or satisfy caller. 
  7. Handles difficult patient calls referred by others and resolves and if unable to resolve documents concerns and refers to appropriate individuals.

Training, policy and procedure development, coordinate and implement new processes, attend training sessions.

  1. Train new and existing customer service employees
  2. Assist management to coordinate and implement new processes.
  3. Attend training courses as appropriate.

 

Qualifications

  1. High School graduate or equivalent.
  2. Associates Degree in Accounting or Finance or Business Administration or completion of a comprehensive coding course or medical billing specialist course.
  3. One year experience as an A/R Specialist I or one year of medical billing experience in either a hospital or physician office setting. 
  4. Ability to use Microsoft Excel and Word as evidenced by the completion of Word and Excel classes or completion of MS Word and Excel as evidenced by CVPH test requirements.
  5. Good written and verbal communication skills are required.
  6. Ability to type 40 WPM with no more than 3 errors required.
  7. Ability to operate a 10 key calculator at 8000 key strokes per hour with a 97% accuracy rate required.
  8. Proven ability to make appropriate decisions based on insurance contractual law and CVPH policy, as evidenced by meeting standards on performance appraisal.   For external candidates, the applicant’s reference(s) must include statements indicating outstanding performance.

 

As applicable, the individual has training/competency in attending to the special needs and/or behaviors appropriate to the age of the patients for which care is being provided.

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