AR Specialist

EyeSouth Partners•Houston, TX

12d•Hybrid

About The Position

The A/R Specialist is responsible for the company’s third-party medical claims processing and assisting patients and office staff with questions on insurance claims, authorizations, statements, and other billing issues. This position will prepare, submit and follow-up on medical claims for Managed Care Organization (MCO), Medicaid, Medicare, Other Federal, Private Insurance, and Workers Compensation. This is a Hybrid Position, the A/R Specialist will be expected to work in person at our Houston Office one day a week. Applicants who live and plan to work from the following states will not be considered at this time: Alaska, Arizona, California, Colorado, Delaware, Hawaii, Idaho, Montana, Maryland, Massachusetts, Michigan, Nevada, New Mexico, Oregon, New Hampshire, New Jersey, Utah, New York, Rhode Island, Washington, and Wyoming. Thank you for your interest.

Requirements

Minimum of two (2) years Medical Insurance/Healthcare Billing and Collections experience in a medical practice or health system
Six months of previous customer service experience preferred
Prior experience with an electronic medical record system required (EHR/EMR)
Working knowledge of medical billing, collections and payment posting, revenue cycle, third party payers, Medicare; and strong knowledge of Federal payer regulations
Working knowledge of CPT and ICD10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits and appeal processes
Ability to handle sensitive and confidential information in a professional manner
Maintains knowledge of coordination of benefits requirements and processes
Demonstrated success working in a team environment focused on meeting organization goals and objectives is necessary
Self-motivated with strong organizational skills and superior attention to detail
Ability to review documents for accuracy and reasonability
Ability to work well under pressure
Ability to multi-task, set priorities and follow through without direct supervision
Effectively communicate with physicians, patients, insurers, colleagues, and staff
Intermediate computer skills including Microsoft Office; especially Word, Excel, and PowerPoint
Knowledge of policies and procedures to accurately answer questions from internal and external customers
Detail oriented and tolerant of frequent interruptions and distractions from patients and staff
Excellent interpersonal skills including the ability to interact effectively and professionally with individuals at all levels; both internal and external
Exercises sound judgment in responding to inquiries; understands when to route inquiries to next level
Team player that develops strong collaborative working relationships with internal partners and can effectively engage and ability to build consensus among cross-functional teams

Nice To Haves

CPC, CPOC, COC certifications a plus
Six months of previous customer service experience preferred

Responsibilities

Files and processes primary and secondary third-party medical
Verifies all the information for claims processing is complete and
Contacts the appropriate person to obtain missing or unclear billing
Follows-up by website and/or telephone on all unpaid and denied claims to determine next course of action, which may require rebilling missing claims, denied claims or sending additional information on pending claims
Sends appeal letters to insurance
Obtains authorizations when needed.
Identifies and corrects charge entry/ billing
Provides proper documentation to insurance companies.
Handles insurance company questions, complaints, and/or r esponds to and interacts with patients concerning all aspects of billing through phone, e-mail, or regular mail in a prompt and courteous
Documents all actions and maintains permanent records of patient
Assists with answering phones, screening calls and following-up on
Works with management on patient billing and insurance
Processes refunds to patients and insurance
Works with outside programs (i.e., co-pay assistance) to ensure proper
Communicates with front office staff to attempt to collect any outstanding patient
Contributes to the team effort by completing other tasks and projects as needed