Job Abstract

JOB DESCRIPTION:

Uphold the mission of the organization by evaluating, reviewing, and collecting on account receivable claims for the Network. The AR Specialist will partner with the billing and financial management staff to ensure the timely and accurate collection of receivables and the reporting and tracking of uncollectible or un-billable services.

Team members are expected to uphold the health centers and organization’s mission by assuring that patients receive health care that is competent, caring, and meets with a high degree of satisfaction.

AGE/PATIENT POPULATIONS SERVED:

ESSENTIAL DUTIES AND RESPONSIBILITIES

Provide oversight and review of aged accounts receivable; make inquiries; collect on open receivables, document, and communicate collection issues or concerns. A review of AR accounts includes the following:

• Responsible for the review and resolution of insurance denials in Epic OCHIN.
  • Resolve denials received from individual payers, as assigned by Supervisor.
  • Work with internal departments to gather and appeal denials with all necessary information.
  • Appeal denials with an eye towards process improvement to reduce future denials.
• Identify accounts with outstanding balances requiring resolution.
  • Ensure accurate and timely follow up of unpaid accounts.
  • Follow-up with third party payers within specified time frames to ensure timely and proper reimbursement.
  • Establish follow up work queue monitoring controls to assess accurate and timely follow up and prevention of third-party denials.
• Actively participate in regularly scheduled Team meetings
  • Provide insight into daily work responsibilities and current trends/issues to immediate supervisor.
  • Report any denial issues in a timely manner to Supervisor.
  • Report any problematic workflows and develop workarounds for possible resolution.
  • Remain up to date on departmental procedures, payer contracts and insurance billing regulations.
• Identify payer trends relating to payer or organizational barriers to cash
• Analyze clinical activity in determination of payment.
• Consistently meet productivity targets and quality assurance guidelines established by the Billing department.
• Keep abreast of contract terms, regulations and receivable changes.
  • Identify and report payer specific trends resulting in incorrect reimbursement by monitoring rejected claims and underpayments.
  • Keep current with insurance regulations and ongoing changes.
  • Keep current with payer contract changes.
  • Identify issues related to contract management system.
• Document all actions in Epic OCHIN system for billing, follow up, and reporting purposes
• Other duties as assigned by Management.

• Knowledge of medical terminology, ICD10, CPT, and HCPCS coding
• Knowledge of dental terminology, CDT coding
• Timely submission of adjustments and write-offs
• Partner with management to understand and contribute to the review of payer contracts or regulations impacting the billing for services and assists with payer billing compliance audits
• Strong organizational skills, ability to multi-task, and managed multiple priorities to meet deadlines.
• Other duties as determined by the Billing Supervisor or Revenue Cycle Director.

PHMC COMPLIANCE RESPONSIBILITIES:

• Understands and adheres to PHMC compliance standards as they appear in the PHMC: Code of
• Conduct, Whistle Blowers, and Conflict of Interest Policies
• Keeps abreast of all pertinent federal, state, and PHMC regulations, laws, and policies as they presently exist and as they change or are modified
• Comply with HIPAA and Confidentiality Policies and Procedures as they apply to the job
• Comply with the Department of Public Health (DPH), The Joint Commission, and other accreditation and regulatory agencies’ standards
• Adhere to all PHMC Policies and Procedures
• Knowledge and adherence to Infection Control and Environment of Care Guidelines and Procedures as described in the annual education module

JOB REQUIREMENTS:

To perform this job successfully, an individual must perform each essential duty satisfactorily. The requirements listed below must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

SKILLS:

• Expert knowledge of Electronic Medical Records including the Practice Management System is required.
• Advanced knowledge of Excel is preferred.
• Strong oral and written communication skills.
• Ability to foster an environment that nurtures collaboration, teamwork, and mutual respect
• Knowledge of billing requirements of Medicare, Medicaid, Commercial payers, and government entities.
• Ability to work within stick timelines and multi-task in an open environment with strong mindfulness and accuracy
• Knowledge of Microsoft Excel
• Excellent communication skills
• Demonstrate exemplary problem-solving, communication, interpersonal, and conflict-resolution skills
• Ability to work effectively as a team member
• Highly responsible and dependable as well as courteous
• Exemplary organizational skills and ability to prioritize
• Unconditional ability to maintain patient confidentiality

EXPERIENCE:

• Minimum of four (4) years working with accounts receivable or billing experience in a medical setting, FQHC preferred
• Computer competency
• Proficient with Excel
• Experience with EPIC EHR, TriZetto(Clearinghouses) preferred

EDUCATION:

• High School Diploma or GED required
• Billing Training Program or Associate Degree preferred.

PHYSICAL DEMANDS:

Position requires standing 2/3 of the time, and walking 2/3 of the time. requires sitting under 1/3 of the time, use of hands to finger, handle, or feel 2/3 of the time, reaching with hands and arms, under 1/3 of the time, stooping, kneeling, crouching, or crawling under 1/3 of the time. talk or hear over 2/3 of the time. The position requires lifting up to 10 lbs. up to 1/3 of the time.

WORK ENVIRONMENT:

Moderate noise (examples: business office with computers and printers, light traffic). Exposure to blood-borne pathogens that require the use of personal protective equipment.

SALARY: Based on education and experience.