Accounts Receivable Representative I

Hospital for Special Surgery•New York, NY

About The Position

The Accounts Receivable Representative I reviews assigned Hospital Billing (HB) and/or Professional Billing (PB) workqueues and follows up on routine unpaid or pending insurance claims. The role contacts insurance carriers, researches payer responses, supports claim resolution, maintains account documentation, and coordinates with internal departments to facilitate timely reimbursement. It also supports departmental productivity, quality, inventory, cash collection, compliance, and process improvement goals.

Responsibilities

Review assigned Hospital Billing (HB) and/or Professional Billing (PB) 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 established 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 and 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, and inventory management benchmarks.
Maintain assigned inventory in accordance with departmental service level expectations and support 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.