Accounts Receivable Specialist

Pinnacle Healthcare Consulting LLC

10h•Remote

About The Position

Pinnacle Healthcare Revenue Solutions (PHRS) is a full Revenue Cycle Management (RCM) company focused on professional billing for independent physician practices. PHRS is a division of Pinnacle Healthcare, a growing healthcare consulting company based in Colorado with regional offices in St. Louis, Missouri, Indianapolis, Indiana, Phoenix, Arizona and remote employees in 23 states. We offer our employees a GREAT team environment, wonderful camaraderie among the team members, and a true appreciation and recognition for hard work. PHRS is comprised of specialists in the areas of coding and charge entry, cash posting, and accounts receivable management for various medical subspecialties utilizing a variety of electronic health record and practice management software platforms to support our clients. Our RCM services incorporate numerous operational efficiencies to capture patient demographics, health status, visit notes, and billing information to provide these critical daily functions in support of each practice. In addition, our management team provides a strategic partnership with our client practices to ensure compliance with all regulatory standards, produce summary reports of all activity; document production and revenue trends; and recommend changes in policy and procedure to create efficient and effective business operations.

Requirements

Minimum 2 years of experience in medical billing or has graduated from an accredited medical college.
Candidate must understand government and managed care payment methodologies and demonstrate knowledge of terms such as contractual adjustment, allowed amount, coinsurance, denial and denial processes.
Knowledge of business office procedures
Ability to establish and maintain an effective working relationships with patients, physicians, client practice staff, and co-workers.
Ability to operate a computer, copier or fax machine
Ability to sort and file materials correctly by alphabetic or numeric systems.
Verbal and written communication skills.
Knowledge of Microsoft Office Products.

Nice To Haves

Associates Degree or higher in Medical Billing and Coding or a related field is preferred.
Experience in billing or health insurance claim processing preferred.
CPT, ICD-9, and HCPCS coding knowledge preferred.
Experience in one or more of the following billing software platforms is preferred - EPIC; Ideal; Allscripts; Centricity; Acumen-Epic; iSalus; Athena
Experience in one or more of the following specialties is preferred – Nephrology; OB/GYN; Gastroenterology; Internal Medicine; Long Term Care.

Responsibilities

Continuously interact with physicians, patients and insurance vendors to investigate outstanding claims and incomplete payments.
Provide first level customer support for billing services which includes answering phones and researching patient account issues.
Complete patient billing and investigate daily denials by working with insurance vendors and adjusters to resolve problem accounts and re-file open claims.
Maintain up-to-date patient demographics and insurance information.
Identify errors through coding, charge entry and cash application processes.
Complete daily denials by working with insurance companies and adjusters to resolve problem accounts, re-file and re-open claims, file appeals and make decisions on adjustments.
Investigate and work claims based on aging from date of service.
Refer refund request to refund specialist.
Provide first level customer service support for billing services including answering patient’s questions and researching account issues. Assist with customer’s pending items including charges, payments and denials and follow-up to confirm these items are resolved.
Document activity in an accurate and timely manner on the patient’s account.
Review and prepare accounts for collections.
Complete and communicate progress on assigned tasks to Manager.
Maintain proficiency and an appropriate level of knowledge with all systems required for task completion.
Ensure compliance with all state and federal billing regulations, including HIPAA, and report any suspected compliance issues to the respective Manager or RCM leadership.
Work with RCM management team to improve processes, increase accuracy, create efficiencies and achieve the overall goals of PHRS.
Other duties as assigned.