ACCOUNTS RECEIVABLE SPECIALIST- Full Time

UHS•Riverside, CA

7h•Onsite

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About The Position

Responsible for the accurate and timely processing of fee-for-service claims and account collections.

Requirements

High school diploma or general education degree required.
Knowledge of medical terminology required.
Two years prior experience in medical billing/collections is REQUIRED.

Responsibilities

Assist the supervisor as requested.
Review, adjust, and/or mail out all assigned tracer claims.
Initiate claim review and/or appeals, as indicated on assigned explanation of benefits.
Review, adjust, and/or process all assigned correspondence.
Work aging AR: Contact insurance carrier to check on claim status and/or responsible party to settle account. Review Explanation of Medical Benefits to verify accuracy of reimbursement. Verify insurance coverage. Initiate necessary account adjustments, change of charges and/or refunds as indicated.
Analyze and investigate denied claims to determine the root cause of denials, including coding errors, missing information, and billing discrepancies.
Prepare and submit appeals for denied claims, utilizing a comprehensive understanding of payer requirements and regulations to maximize the likelihood of successful resolution.
Resubmit corrected claims with the appropriate documentation and follow up to ensure timely processing.
Communicate with insurance companies, payers, and other relevant parties to resolve denials and obtain information needed for appeals and/or resubmission.
Maintain regular follow-up with insurances and responsible parties to track the progress of appealed claims and pending actions. Escalate as necessary to achieve successful resolution.
Stay informed about industry changes, billing regulations, and payer policies to ensure compliance with applicable laws and best practices.
Manage and resolve claims with pending responses from insurance companies and/or other parties.
Track and follow up on unpaid claims and/or incomplete documentation.
Review account with no response and communicate with relevant parties to obtain necessary information.
Document all interactions and actions taken.
Display a professional attitude through performance, appearance, and demeanor.