A/R Specialist II

Inspire Health Medical Group•Fresno, CA

About The Position

JOB PURPOSE: Position is responsible for researching and resolving outstanding claims issues to ensure maximization of claims reimbursement. JOB FUNCTIONS: Monitor all payer types on unresolved claims by running appropriate reports and contacting insurance companies to resolve claims that are not paid in a timely manner outbound calls required Follow up on all outstanding insurance accounts Research denials and requests/inquiries from insurance payers Retrieve supporting documentation from the hospital system for accurate and timely processing of claims Possess full understanding of EOB’s to ensure payment accuracy and compliance with contract discount. Identifies, analyzes and escalates trends impacting AR reimbursement Responsible for outreach to payers to validate incomplete or invalid insurance information Review and recommend claims for adjustment/write off to management. Initiate 1st level appeals for denied claims as appropriate Document clear, concise and complete follow up notes in system for each account worked Contact third party payers and patients to expedite and maximize payment Work error reports in a timely manner (set by Director/Manager) Meet with assigned site managers as needed Collaborate with management to reduce aging of accounts by providing verbal and written communication Demonstrates proficiency of all payers, including Medicare, Medi-Cal and commercial payers Perform other related duties as assigned

Requirements

High school education or equivalent, with specialized training.
One to three years or more working specifically in professional medical billing and collections accounts receivable
Two years’ experience using Medical Billing software and Applications
Experience handling confidential data i.e., patient demographic information, payor fee schedules, reimbursement rates, etc.
Knowledge of current CPT-4 and ICD-10 coding.
Knowledge of medical terminology and health insurance billing.
Knowledge of common insurance plans, i.e., HMO, PPO, Capitation, Medicare and Medi-cal
Good research skills
Decision Making
Analytical and problem-solving skills with attention to detail
Strong verbal and written communication
Excellent customer service skills
Proficient computer skills and knowledge of Microsoft Office
Ability to understand and interpret policies and procedures.
Ability to communicate effectively and work with others.
Ability to apply principles of analytical thinking to extract correct data from documentation.
Ability to prioritize and manage multiple tasks.
Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction.
Ability to work in a fast-paced environment
Involves sitting approximately 90 percent of the day, walking or standing the remainder. Some bending, stooping, and lifting up to 15 pounds.

Responsibilities

Monitor all payer types on unresolved claims by running appropriate reports and contacting insurance companies to resolve claims that are not paid in a timely manner outbound calls required
Follow up on all outstanding insurance accounts
Research denials and requests/inquiries from insurance payers
Retrieve supporting documentation from the hospital system for accurate and timely processing of claims
Possess full understanding of EOB’s to ensure payment accuracy and compliance with contract discount.
Identifies, analyzes and escalates trends impacting AR reimbursement
Responsible for outreach to payers to validate incomplete or invalid insurance information
Review and recommend claims for adjustment/write off to management.
Initiate 1st level appeals for denied claims as appropriate
Document clear, concise and complete follow up notes in system for each account worked
Contact third party payers and patients to expedite and maximize payment
Work error reports in a timely manner (set by Director/Manager)
Meet with assigned site managers as needed
Collaborate with management to reduce aging of accounts by providing verbal and written communication
Demonstrates proficiency of all payers, including Medicare, Medi-Cal and commercial payers
Perform other related duties as assigned