AR and Denial Lead

Lakeshore Bone & Joint Institute•Chesterton, IN

1d•Onsite

About The Position

This role involves reviewing and overseeing accounts receivable reports, training staff on best practices, and managing patient accounts to ensure accurate and timely claim filing. The lead will research unpaid and denied insurance claims, verify documentation for paper claims, and initiate appeals or refile denied claims. Responsibilities also include requesting refunds, acting as an internal resource for staff questions, and maintaining a deep understanding of insurance rules, coding, explanations of benefits, and billing procedures. The position requires developing network connections with insurance providers, communicating billing issues and denial trends with solutions, coordinating electronic payments, and responding to patient inquiries regarding financial accounts. The lead will also review insurance carrier updates, maintain confidentiality and HIPAA compliance, adhere to company policies, and attend required meetings.

Requirements

Knowledge of CPT and ICD-10 codes
Knowledge of an Explanation of Benefits
Teamwork and conflict resolution
Adaptive and flexible
Professionalism and work ethic
Must be at least 18 years of age
Must have reliable transportation
Proficiency in Microsoft Word, Excel, and Outlook
Digital literacy
Ability to analyze situations and solve problems
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 and oversee accounts receivable reports / queues daily.
Assist in training best practices and AR management processes.
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.
Act as internal resource for staff questions.
Have an in-depth understanding of insurance rules and regulations, CPT/ICD10 coding information, explanation of benefits and company billing procedure(s).
Develop and establish network connections with insurance provider representative(s) as well as other critical department(s) within insurance carrier(s).
Communicate with team member(s) and the Revenue Cycle Director 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, mailing and announcements share updates with the billing department and A/R Specialist Supervisor.
Maintain confidentiality and compliance with HIPAA rules and regulations.
Maintains LBJI handbook policy and reports any violations to appropriate management.
Attend meetings as required.
Other duties as assigned.