Accounts Receivable Specialist

The Medical Insurance Accounts Receivable Representative is responsible for ensuring the timely collection of outstanding government or commercial healthcare insurance receivables.

Responsibilities:

• Verifies or obtains patient eligibility and/or authorization for healthcare services performed by searching payer web sites or client eligibility systems, or by conducting phone conversations with the insurance carrier or healthcare providers. 
• Updates patient demographics and/or insurance information in appropriate systems. 

• Conducts research and appropriately statuses unpaid or denied claims.  
• Monitors claims for missing information, authorization and control numbers (ICN//DCN). 
• Researches EOBs for payments or adjustments to resolve claims. 
• Contacts payers by phone or through written correspondence to secure payment of claims. 
• Accesses client systems for information regarding received payments, open claims and other data necessary to resolve claims. 

• Follows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems. 
• Secures medical documentation as required or requested by third party insurance carriers. 
• Obtains billing guidelines and requirements by researching provider billing manuals.  
• Writes appeal letters for technical appeals. 
• Verifies accuracy of underpayments by researching contracts and claims data. 

• In the event of an authorization, coding, level of care and/or length of stay denial, prepares claims for clinical audit processing.  
• Supports Savista Compliance Program by adhering to policies and procedures pertaining to HIPAA, FDCPA, FCRA, and other laws applicable to Savista  business practices. This includes: becoming familiar with Savista's Code of Ethics, attending training as required, notifying management or Savista  Helpline when there is a compliance concern or incident, HIPAA-compliant handling of patient information, and demonstrable awareness of confidentiality obligations. 

Requirements:

• High school diploma or GED. 
• At least two years of experience in healthcare insurance accounts receivable follow up, working with or for a hospital/hospital system, working directly with government or commercial insurance payers. 

• Experience identifying billing errors and resubmitting claims as well as following up on payment errors, low reimbursement and denials. 
• Experience reviewing EOB and UB-04 forms to conduct A/R activities. 
• Knowledge of accounts receivable practices, medical business office procedures, coordination of benefit rules and denial overturns and third-party payer billing and reimbursement procedures and practices.  
• At least two years of experience with accounts receivable software. 
• Experience navigating payer sites for appeals/reconsiderations, benefits verification and online claims follow up. 

• Demonstrated ability to navigate Internet Explorer and Microsoft Office, including the ability to input and sort data in Microsoft Excel and use company email and calendar tools. 
• Demonstrated success working both individually and in a team environment. 
• Demonstrated experience communicating effectively with payers, understanding complex information and accurately documenting the encounter. 
• Ability to work effectively with cross-functional teams to achieve goals. 
• Demonstrated ability to meet performance objectives. 
• Productivity requirements are 45 claims per date/225 claims per week.

Preferred Skills:

• Experience with Epic, Meditech, Cerner, Invision, Paragon, Soarian, Collections Management or STAR. 
• Experience working with or for a hospital/hospital system with more than 250 beds. 
• Experience with both hospital (facility) and physician (pro-fee) A/R. 

Note: Savista is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $18.00 to $22.00. However, specific compensation for the role will vary within the above range based on many factors including but not limited to geographic location, candidate experience, applicable certifications, and skills