Accounts Receivable Specialist

Responsible for billing and collecting inpatient and outpatient 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 the Medical Center.

The base starting pay for this position is $19.34-$25.14, with the offered rate dependent on relevant experience. A one-time sign-on bonus of $4,000, subject to applicable taxes, is available for this role. This amount is payable in 3 increments: the first third is payable upon hire, and the second third is payable at six months, and the final third is payable after one year. This bonus requires a two-year commitment to employment at CVPH. Please note that current University of Vermont Health Network employees are excluded from eligibility for this bonus. Additional terms and conditions apply.

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 system or edit issues 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. Demonstrates a thorough understanding of all applicable insurance regulations and contractual requirements and reviews all appropriate insurance bulletins in a timely manner.
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 payer 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.

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.

    ESSENTAIL 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.

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.

1. 1. High School graduate or equivalent.
   2. One (1) year medical billing experience including electronic claims preferred.
   3. AA degree in Accounting, Finance, Business Administration or Legal OR completion of comprehensive medical billing and coding course from an accredited organization as evidence by a certificate of completion or transcript.      
   4. Ability to pass a data entry test with an accuracy score of 95%.
   5. One year customer service experience and must be comfortable following up with payers.
   6. Proficient in MS Word.
   7. Thoroughness, attention to detail, and follow through is required until accounts are resolved.

    

   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.