AR Specialist Profee Follow Up Biller - REMOTE WORK

Quadris Team LLC

1d•Remote

About The Position

Quadris Team, LLC - A Revenue Cycle Management Group, is searching for that dynamic person to join us, working with our Clinic AR Excellence team to fill the role of AR Specialist Profee Follow up. We are a 100% remote team supporting our Hospital and Physician clients across the United States! See us at www.quadristeam.com We are looking for high performing, passionate and results driven team members to join our group. Location: REMOTE - Work from Home Opportunity Ideal candidate will reside in PST, MST or CST time zones Job FOCUS: This position is responsible for Billing, Re-Billing, Post-payment and Account Follow-up and/or grievance preparation of assigned Client EMR Accounts Receivable. The responsibilities may include account maintenance of specialized or multiple payers including state and federal government programs, managed care, commercial and other insurance groups. Partners with other team members and health plans to facilitate the appropriate and prompt payment of claims. This individual must demonstrate a commitment to the organization's strategic plans, short and long-term goals and mission, vision and values by representing the company in a caring and professional manner. Primary / Essential Expectations For Success: The Primary responsibilities and essential job duties effectively and efficiently performed include but are not limited to the following: BILLING Reviews and/or scrubs final billed initial claims for accuracy and completeness prior to submitting to payer Calculates Tier, Outlier, DRG and/or other Fee Schedule based reimbursement Submits electronic and/or hard copy claims with any attachments as per the contract timely filing criteria Documents all account activity in the hospital system and The Q with clear and concise notes INSURANCE FOLLOW-UP Within appropriate timeframes, contact the health plan by phone or website to determine status of claim Documents all follow-up actions in the hospital account notes and database and sets up account for additional review based on client expectations for follow-up of unresolved accounts POST PAYMENT REVIEW Researches and validates the paid or partially paid claim status is in accordance with the expectations outlined in the client contract agreement Deliberately and thoroughly reviews any denied, dis-allowed, or non-covered claims / charges and determines accuracy based on contract language Resolves any technical issues when warranted with payer Follows client specific procedures to request adjustments and refunds Prepares appeal and necessary documentation for authorization, coding, level of care and/or length of stay denials Follow guidelines for prioritization and timely filing deadlines Physical / Mental Demands, Environment: Prolonged periods of sitting at a desk and working on a computer Must be able to lift 15 pounds at one time Must be able to structure your home office to ensure patient information is secure meeting the regulatory expectations

Requirements

Maintains compliance with regulations and laws applicable to job
Professional level of communication with video, phone and email
Ability to effectively prioritize the work to meet deadlines and expectations
Meets the quality and productivity measures as outlined by Quadris
Brings positive energy to work
Uses critical thinking skills
Being present and focused on assigned tasks and eliminates distractions
Being a self-starter
Ability to work independently and within a team atmosphere
High School diploma or equivalent
2+ years previous experience in healthcare revenue cycle management
Ability to work independently and within a team atmosphere
Advanced proficiency of CPT and ICD-10, and full-scope revenue cycle management framework
Self-motivated and passionate about our mission and values of quality work
Must have professional level skills in MS products such as Excel, Word, Power Point.
Proficient application of business/office standard processes and technical applications

Nice To Haves

Active national certification CRCR through Healthcare Finance Management Organization (HFMA), or can test successfully for the certification within 6 months from hire date

Responsibilities

Reviews and/or scrubs final billed initial claims for accuracy and completeness prior to submitting to payer
Calculates Tier, Outlier, DRG and/or other Fee Schedule based reimbursement
Submits electronic and/or hard copy claims with any attachments as per the contract timely filing criteria
Documents all account activity in the hospital system and The Q with clear and concise notes
Within appropriate timeframes, contact the health plan by phone or website to determine status of claim
Documents all follow-up actions in the hospital account notes and database and sets up account for additional review based on client expectations for follow-up of unresolved accounts
Researches and validates the paid or partially paid claim status is in accordance with the expectations outlined in the client contract agreement
Deliberately and thoroughly reviews any denied, dis-allowed, or non-covered claims / charges and determines accuracy based on contract language
Resolves any technical issues when warranted with payer
Follows client specific procedures to request adjustments and refunds
Prepares appeal and necessary documentation for authorization, coding, level of care and/or length of stay denials
Follow guidelines for prioritization and timely filing deadlines