Medical Accounts Receivable Specialist 3

Hologic•San Diego, CA

About The Position

Medical AR Specialist 3 Under minimal supervision and with a high level of knowledge, skills and experience, Accounts Receivable Specialist 3 performs a variety and full range functions related to Biotheranostics customer service, billing, appeals and accounts receivable resolution. Functions include but are not limited to billing, Third Party Payer follow-up, trend and A/R analysis, account inquiry resolution and appeals. In addition to specific duties, position may assist in other areas as needed to minimize risks related to achieving financial performance. Primary Responsibilities: Responsible for their own appeal creations, reviewing and submitting first, second and third level appeals to insurance companies Reviewing/submitting AR Specialist 2, level 2 and level 3 appeals Conduct root cause analysis and process improvement Responsible for filing all level 3 appeals to include: external appeals (DOI complaints & CMS complaints), member appeals Works special projects as assigned May present findings to management Uses independent judgement to solve issues Timely, effective follow up and maximize collection of assigned Third Party Payer outstanding A/R and denials. Analysis and timely reporting related to Third Party Payer A/R, denials and overall payer performance Trend, payer issue, cash flow disruption identification, tracking, reporting and resolution Processing, validation of payer requests and processed claims via correspondence, remittance advice and EOBs (i.e. identification of payment discrepancies, inappropriate requests) Timely, effective processing of assigned appeals including development, submission, tracking, reporting and evaluation of appeal outcomes (i.e. next steps, improved outcomes) Maximize utilization of Billing system, tools and resources to support cash collection activities Keep current with all payer regulations, guidelines and provider/payer contract terms Effectively manage incoming calls, resolve internal and external customer inquiries regarding all aspects of patient and/or client accounts Support and maintain department cash and DSO goals Data entry, correct insurance assignment to patient accounts, insurance eligibility verification. Review/update demographics and patient information for accuracy. Performs additional tasks, projects, special assignments as required Must be able to work under minimal supervision Actively participates in team meetings, provides insight when asked May be asked to present a topic during team meetings Meets Level 3 daily and monthly productivity requirements

Requirements

High school diploma (or GED equivalent)
Minimum 5 plus years’ experience- all aspects of patient account management and resolution with an emphasis on Third Party Payers, A/R and denial resolution, preferably in a laboratory environment
Must be able to demonstrate strong knowledge of commercial and government health plan requirements, guidelines, billing practices and regulations
Support cross-trained culture
Ability to easily adapt to increased business demands
Ability to effectively work with and resolve complex accounts & billing issues
Self-starter, ability to work independently
Excellent troubleshooting and time management skills, attention to detail, utilizes time in a constructive manner
Flexible and reliable
Ability to effectively prioritize and multi-task
Ability to work in fast paced environment, perform under pressure, meet tight timelines
Establish and maintain cohesive and good working relationships
Excellent communication and customer service skills; cooperative, work collaboratively and treat others in respectful, professional and supportive manner
Working knowledge of ICD-10, CPT, LCD/NCD and reimbursement associated with such codes
Ensure compliance with all state and federal billing a HIPAA regulations
Strong knowledge and experience with Microsoft Excel as well as Word and Outlook, general office equipment, ten key by touch
Desire to learn and apply learned concepts to various situations
Intermediate Xifin experience

Responsibilities

Responsible for their own appeal creations, reviewing and submitting first, second and third level appeals to insurance companies
Reviewing/submitting AR Specialist 2, level 2 and level 3 appeals
Conduct root cause analysis and process improvement
Responsible for filing all level 3 appeals to include: external appeals (DOI complaints & CMS complaints), member appeals
Works special projects as assigned
May present findings to management
Uses independent judgement to solve issues
Timely, effective follow up and maximize collection of assigned Third Party Payer outstanding A/R and denials.
Analysis and timely reporting related to Third Party Payer A/R, denials and overall payer performance
Trend, payer issue, cash flow disruption identification, tracking, reporting and resolution
Processing, validation of payer requests and processed claims via correspondence, remittance advice and EOBs (i.e. identification of payment discrepancies, inappropriate requests)
Timely, effective processing of assigned appeals including development, submission, tracking, reporting and evaluation of appeal outcomes (i.e. next steps, improved outcomes)
Maximize utilization of Billing system, tools and resources to support cash collection activities
Keep current with all payer regulations, guidelines and provider/payer contract terms
Effectively manage incoming calls, resolve internal and external customer inquiries regarding all aspects of patient and/or client accounts
Support and maintain department cash and DSO goals
Data entry, correct insurance assignment to patient accounts, insurance eligibility verification.
Review/update demographics and patient information for accuracy.
Performs additional tasks, projects, special assignments as required
Must be able to work under minimal supervision
Actively participates in team meetings, provides insight when asked
May be asked to present a topic during team meetings
Meets Level 3 daily and monthly productivity requirements