Variance Accounts Receivable Specialist II

St. Luke’s University Health Network•Allentown, PA

About The Position

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Accounts Receivable Specialist II is responsible for the day to day operations of accounts receivable for the facilities and practices including billing, account resolution, credits workflow and processes. The Accounts Receivable Specialist II is focused on the accurate and timely submission of claims to third party payers, intermediaries, and guarantors in accordance with network policy. Proactively reviews accounts with insurance payers to ensure prompt and maximum reimbursement.

Requirements

High School Diploma or equivalent.
Must be able to speak, read and write English.
Strong verbal and writing skills.
Must have one to two years’ experience at AR Specialist Level within the network or comparable work environment.

Nice To Haves

Experience with third party billing in a hospital similar medical facility or physician’s office is preferred.

Responsibilities

Process all UB04 and HCFA-1500 claims through the related billing system, working the related claims scrubber in a timely and efficient manner; performs all associated duties in order to ensure the completeness and accuracy of all claim information, facilitating maximum reimbursement.
Performs duties as scheduled, prioritizing as required to ensure claims are submitted timely, and maximize cash flow is received.
Verifies accuracy of billing data and makes revisions as need be.
Identifies and reports any claim submission issue trends to Coordinator/Management team.
Uses insurance websites for claim status, appeals and corrections.
Obtains and maintains a basic understanding of third party billing requirements as assigned, including federal, state and commercial payers.
Responsible for accounts receivable and investigates and reviews number of claims set by productivity standards for the team.
Analyzes daily aging of high balance insurance accounts, via the billing system to determine appropriate follow up for non- payment and delayed payment accounts, as well as to ensure compliance with all Federal, state, insurance payer and St. Luke’s Network policies.
Analyzes denied claims and investigates the reasons causing the denial and takes the necessary action to resolve the denial and/or resolution of the account.
Seeks resolution to problematic accounts and payment discrepancies with optimal goal of receiving accurate payments and maximum reimbursement.
Refers accounts back to billing staff for any claims that need to be re-billed.