Accounts Receivable Specialist

Lakeshore Bone & Joint Institute•Portage, IN

21d•Hybrid

About The Position

The Accounts Receivable Specialist is responsible for filing insurance claims, denial management and adjudication according to LBJI contracts. This role involves reviewing accounts receivable reports daily, managing patient accounts for accurate and timely claim filing, and researching unpaid and denied insurance claims to ensure resolution and payment. The specialist will verify documentation for paper claims, initiate appeals or refile denied claims, and request refunds as per LBJI policies. They will also organize medical billing information, obtain retro authorizations, and serve as an internal resource for staff questions. A deep understanding of insurance rules, CPT/ICD10 coding, explanation of benefits, and company billing procedures is essential. The role requires developing network connections with insurance providers and internal departments, communicating billing issues and denial trends to the Billing Manager and team, and presenting problems with solutions. Coordination with insurance carriers for electronic payments and remittances, and responding to patient inquiries about financial accounts are also key responsibilities. The specialist will stay updated on insurance carrier announcements and maintain HIPAA confidentiality. Attendance at required meetings and performance of other assigned duties are expected.

Requirements

High school diploma or the equivalent
Knowledge of CPT and ICD-10 codes
Knowledge of Explanation of Benefits
Proficiency in Microsoft Word, Excel, and Outlook.
Digital literacy.
Employ critical thinking and problem solving.
Ethical reasoning and decision making
Strong attention to detail
Receptive and responsive to feedback
Excellent verbal and written communication skills
Time management, prioritization, and sense of urgency
Maintain patient confidentiality.

Nice To Haves

Minimum of 2-year medical insurance experience preferred.

Responsibilities

Review accounts receivable reports daily.
Manage patient account(s) to ensure accurate and timely filing of all claims.
Research unpaid and denied insurance claims in an expeditious manner to ensure account resolution and claim payment.
Verify accuracy and completeness of documentation included with paper claims prior to submission.
Initiate appeals and/or refile claims for all denials.
Request refunds according to LBJI policies and guidelines.
Organize and gather medical billing upon requests from insurance companies, attorney offices, and audit contractors.
Obtain retro authorizations as needed.
Function as internal resource for staff questions.
Develop and establish network connections with insurance provider representative(s) as well as other critical department(s) within insurance carriers(s).
Communicate with team member(s) and the Billing Manager regarding billing issue(s), insurance process(es) and denial trends.
Present problems to team with a solution-based approach.
Coordinate with insurance carriers to obtain electronic payments and remittances for payments to LBJI.
Meet and respond to patient requests for assistance and/or questions regarding financial accounts, insurance payment and patient balances.
Review insurance carrier newsletters, mail announcements and share updates with the billing department and A/R Specialist Supervisor.
Maintain confidentiality and compliance with HIPAA rules and regulations.
Attend meetings as required.
Other duties as assigned.