This position is responsible for the timely analysis and reconciliation of insurance accounts receivable (AR), including but not limited to standard insurance aging, insurance and third party denials and claims appeals. He or she must provide guidance and support to senior business leaders within the firm and serve as liaison between various revenue cycle departments.
Essential Functions:
- Responsible for advising leadership on potential quality and risk management issues across the organization.
- Perform various projects requiring in-depth account and/or report analysis. Assist in identifying and resolving the root cause issues. Document and report findings.
- Identify areas of opportunity and create action plans to implement solutions for Business Office operations including; pre-financial clearance, registration, revenue capture, billing, and collections to reduce overall rework and denials.
- Perform in-depth analysis requiring account research to identify accounts receivable trends by payer, financial class, department, and area. Assist in identifying and resolving the root cause issues. Document and report findings.
- Identify areas of opportunity and create action plans to implement solutions based on AR analysis, including agings reduction, backlog reduction, and cash acceleration
- Research, identify, and rectify any problems that may cause denials of payment and complete action steps necessary for resolution according to appropriate policy, re-bill or appeal as necessary to obtain full payment on services rendered
- Appropriately document each action taken on every account in the patient accounting systems/host systems
- Make on-going follow-up calls to the appropriate payer, patient, or other parties to expedite resolution on accounts
- Create and submit Medicare claims in a timely manner, while adhering to all Medicare regulations and guidelines
- Review and resolve all billing edits, and submit claims and rebills to payers daily in paper and/or electronic format to ensure accurate and timely filing of claims and prompt payment
- Process claims for secondary insurance carriers, attaching all required documentation to ensure claims are filed to appropriate payers
Qualifications:
Basic Qualifications:
- Bachelors Degree or equivalent related experience, and a minimum of 5 years Healthcare Industry experience.
- Well developed problem solving skills are necessary
- Strong interpersonal and communication skills
- Must have advanced knowledge of MS office
- Ability to analyze large amounts of data and provide appropriate action plan
- Strong understanding of accounts receivable and factors that effect AR movement
- Strong oral and written communication skills
- Ability to handle fast paced, multi-task environment
- Ability to work both in a team and autonomously
- Understand the flow of information from point of visit to collection and account resolution
Preferred Qualifications:
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External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.