[Hiring] Accounts Receivable Escalation Specialist @Ventra Health

Role Description

The Accounts Receivables Escalation Specialist are primarily responsible for analyzing collections, resolving non-payables, and handling bill inquiries for more complex issues. AR Representatives are responsible for insurance payer follow-up ensuring claims are paid according to client contracts. Complies with all applicable laws regarding billing standards.

• Follows up on claim rejections and denials to ensure appropriate reimbursement for our clients.
• Process assigned AR work lists provided by the manager in a timely manner.
• Write appeals using established guidelines to resolve claim denials with a goal of one contact resolution.
• Identified and resolved denied, non-paid, and/or non-adjudicated claims and billing issues due to coverage issues, medical record requests, and authorizations.
• Recommend accounts to be written off on Adjustment Request.
• Reports address and/or filing rule changes to the manager.
• Check the system for missing payments.
• Properly notates patient accounts.
• Review each piece of correspondence to determine specific problems.
• Research patient accounts.
• Reviews accounts and determines appropriate follow-up actions (adjustments, letters, phone insurance, etc.).
• Processes and follows up on appeals. Files appeals on claim denials.
• Scan correspondence and index to the proper account.
• Inbound/outbound calls may be required for follow-up on accounts.
• Respond to insurance company claim inquiries.
• Communicates with insurance companies about the status of outstanding claims.
• Meet established production and quality standards as set by Ventra Health.
• Performs special projects and other duties as assigned.

Qualifications

• High School Diploma or GED.
• At least one (1) year in the data entry field and one (1) year in medical billing and claims resolution preferred.
• AAHAM and/or HFMA certification preferred.
• Experience with offshore engagement and collaboration desired.

Requirements

• Intermediate level knowledge of medical billing rules, such as coordination of benefits, modifiers, Medicare, and Medicaid, and understanding of EOBs.
• Become proficient in the use of billing software within 5 weeks and maintain proficiency.
• Ability to read, understand and apply state/federal laws, regulations, and policies.
• Ability to communicate with diverse personalities in a tactful, mature, and professional manner.
• Ability to remain flexible and work within a collaborative and fast-paced environment.
• Basic use of a computer, telephone, internet, copier, fax, and scanner.
• Basic touch 10 key skills.
• Basic Math skills.
• Understand and comply with company policies and procedures.
• Strong oral, written, and interpersonal communication skills.
• Strong time management and organizational skills.
• Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills.

Benefits

• This position is eligible for our Ventra performance-based incentive plan.
• Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons.
• This position is also eligible for a discretionary incentive bonus in accordance with company policies.