REP RCM ACCOUNTS RECEIVABLE III

AMSURG•Nashville, TN

43d•Remote

About The Position

The Rep, RCM Accounts Receivable III is responsible for managing and resolving complex accounts receivable with a primary focus on Workers' Compensation claims, which represent the majority of the assigned inventory. This role also supports Auto Liability and Personal Injury (PI) accounts by conducting claim follow-up, resolving denials, appealing underpayments, and ensuring timely reimbursement. The ideal candidate has strong knowledge of Workers' Compensation billing and collections, payer regulations, and revenue cycle management, with the ability to independently resolve aged and complex accounts while meeting productivity and quality standards.

Requirements

Working knowledge of CPT, ICD-9 and ASA codes
Strong mathematical, research, analysis, decision making and problem-solving skills.
Strong data gathering and reporting skills.
Working knowledge of medical terminology, insurance processing guidelines and laws.
Demonstrates advanced understanding of commercial, Medicare and Medicaid payers
Working knowledge of TWCC guidelines and laws, commercial managed care insurance, Medicare and Medicaid guidelines.
Strong interpersonal skills and comfortable working with physicians, external customers, hospital staff, co-workers and senior leadership.
Strong verbal and written communication skills
Team oriented, must have a pleasant disposition and high tolerance level for diverse personalities.
Ability to work independently with limited supervision.
Demonstrates advanced understanding of claim needs and ability to accurately perform needed billing activities (Evaluation/Correction of billing edits, claim transmission, rejections, and other claim functions)
High School graduate or equivalent.
3 to 5 years’ experience in a healthcare insurance receivables environment
Two - three years collection experience required.
Working knowledge of PC applications (MS Office, Word and Excel).

Nice To Haves

Associate or bachelor’s degree in business administration or related field preferred
Two years posting, coding or accounts receivable collection experience in health care organization is preferred.

Responsibilities

Follow-up on outstanding claims and appeals
Work escalation views
Review Vendor Clarification logs
Provide employee and vendor training
Acts as a knowledge resource for team members
Not limited to working Claim Ack Rejections, Claim Edits & Charge Corrections
Phone patients for payment or payment arrangements
Print and re-file claims as needed.
Work correspondence daily.
Maintain continuing education, training in industry career development
Exceed productivity standards as outlined by business line
Answer incoming patient insurance company and physician office telephone calls.
Research/audit patient accounts for further payment or adjustments.
Work KAM reports as assigned.
Work accounts receivable collector queue with proficiency within 30-60 days of employment.
Work 40-50 accounts daily with > or =90% accuracy rating; meet department productivity standards.
Calculate billing unties and reimbursement amounts.
Maintain strictest confidentiality and adhere to all company policies and procedures.
Other duties as assigned
Reads and abides by the company’s code of conduct, ethics statements, employee handbook(s), policies and procedures and other corporate mandates, including participation in mandatory training programs
Reports any real or suspected violation of the corporate compliance program, company policies and procedures, harassment or other prohibited activities in accordance with the reporting policies of the company
Obtains clarification of policy whenever necessary and may use the resources available through the Compliance, Human Resources or Legal Department to do so
Support and abide by the values of the company