Specialist-Accounts Receivable Follow Up

Baptist•Memphis, TN

About The Position

The Accounts Receivable Follow Up Specialist performs collection and follow-up activities with third-party payers to resolve outstanding balances and secure accurate, timely claim adjudication. The role is responsible for net and gross accounts receivable, the percentage of accounts aged over 90 days, cash collections, and denials resolution in support of team performance goals. The Specialist performs daily activities to close aged accounts receivable successfully. The position monitors assigned work queues, checks account and claim status, contacts payers, responds to denials, and takes actions needed to secure payment or close accounts. It requires clear documentation in the EMR, coordination with other departments, compliance with patient confidentiality and applicable laws and payer requirements, and communication of unresolved issues and repetitive denials to supervisors. The Specialist is expected to meet established productivity and quality standards.

Requirements

Experience in a healthcare setting or educational coursework.
PC skills and keyboarding, including working knowledge of 10-key, typing, and computers.
Proficiency in Microsoft Office.
Ability to type and key accurately.
Problem-solving skills.
Written and oral communication skills.
Financial counseling skills and knowledge of insurance billing in hospital and professional settings, collections, and insurance guidelines, including CMS guidelines and applicable TennCare or state Medicaid requirements.
Ability to recognize and communicate to clinical staff or a designee when insurers require additional review because of NCCI, CCI, LMRP, mutually exclusive, or medical necessity edits.
Effective verbal, written, and customer service skills when communicating with patients and insurance companies.
Ability to create communications to patients and insurance companies as needed to resolve issues and complete billing and claim processes.

Nice To Haves

One year of experience in a physician’s office or hospital setting.
Knowledge of insurance billing and collections and insurance guidelines.
Knowledge of ICD-9, ICD-10, CPT, and HCPCS codes.
Certification and/or a degree in Healthcare Administration, Business, Finance, or a related field.

Responsibilities

Performs online account status checks and contacts payers to follow up on outstanding claim balances in assigned work queues.
Documents patient account notes, payment status, and actions taken in the EMR; requests additional follow-up within prescribed timeframes based on payer filing requirements or processing times.
Takes actions to resolve account balances promptly, including submitting appeals, correcting account information, coordinating medical-record requests, requesting or performing account adjustments, requesting rebills, and other actions needed to secure payment or close accounts.
Documents, tracks, and ensures reasonable turnaround for receipt of outstanding documents from external departments.
Responds to payer claim denials, including denials involving patient identification, coordination of benefits, non-covered services, and timely filing, and ensures the payer receives required information.
Documents all account actions in EMR notes so prior actions are clear and understandable.
Informs the supervisor of problems or changes in payer requirements and analyzes and reports repetitive denials to support corrective action.
Achieves productivity and quality standards established in the Baptist Productivity and Quality Expectations Documentation.
Maintains knowledge of applicable rules, regulations, policies, laws, guidelines, and accreditation and health-plan program requirements affecting patient account collections; adheres to internal controls and applicable state and federal laws.
Seeks advice and guidance as needed to ensure proper understanding.
Uses payer websites as needed to perform daily tasks.
Conducts claim status and follow-up activities and resolves claim payment denials.
Monitors assigned work queues across all sources and works with other departmental representatives to resolve accounts promptly.
Reports unresolved issues and concerns that impede collections or account resolution.
Complies with patient confidentiality policies when retaining, handling, distributing, or disposing of patient health information.
Performs other duties as assigned by the Supervisor.