Accounts Receivable Representative I

Hospital for Special Surgery•New York, NY

About The Position

The Accounts Receivable Representative I reviews routine unpaid or pending hospital and/or professional billing insurance claims, contacts payers to resolve status and information issues, and supports timely reimbursement. The role handles routine denials and claim-resolution steps, coordinates with internal departments, and maintains thorough account documentation and follow-up records. The representative meets departmental productivity, quality, inventory, and service-level expectations while supporting accounts receivable reduction and cash collection goals. The role also follows payer regulations, hospital policies, departmental procedures, and HIPAA requirements, and participates in team meetings, training, quality reviews, and process improvement initiatives.

Responsibilities

Review assigned Hospital Billing and/or Professional Billing workqueues for routine unpaid or pending insurance claims.
Contact insurance carriers regarding claim status, missing information, and routine reimbursement issues.
Research payer responses and follow departmental workflows to facilitate timely reimbursement.
Escalate complex reimbursement issues requiring additional review.
Review routine denial information and identify appropriate next steps.
Assist with corrected claims, reconsiderations, appeals, and supporting documentation as directed.
Coordinate with internal departments to obtain information needed for claim resolution.
Support timely resolution of assigned accounts.
Maintain complete, accurate, and timely account documentation, including payer communications, account activity, follow-up actions, and claim history.
Communicate with Coding, HIM, Patient Access, Billing, Cash Posting, and other departments regarding routine claim issues.
Route accounts requiring additional review with supporting documentation, monitor routed accounts, and follow up as appropriate.
Escalate unresolved issues when departmental turnaround times are exceeded.
Meet established productivity, quality, aging, inventory management, and service-level benchmarks.
Support departmental accounts receivable reduction and cash collection goals.
Participate in departmental process improvement initiatives, meetings, huddles, training sessions, and quality reviews.
Ensure follow-up activities comply with payer regulations, hospital policies, and departmental procedures.
Protect confidential patient and financial information in accordance with HIPAA requirements.
Maintain current knowledge of payer policies, Epic workflow updates, and departmental procedures.
Communicate effectively with peers and internal departments, adapt to changing assignments and priorities, and maintain satisfactory attendance and punctuality.