[Hiring] AR Specialist 2- Complex Clinical Denials @Savista

Role Description

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

• Verify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the insurance carrier/providers
• Update patient demographics/insurance information in appropriate systems
• Research/Status unpaid or denied claims
• Monitor claims for missing information, authorization, and control numbers (ICN//DCN)
• Research EOBs for payments or adjustments to resolve claim
• Contact payers via phone and/or written correspondence to secure payment of claims; reconsideration and appeal submission
• Adhere to state and federal claim and appeal guidelines
• Access client systems for payment, patient, claim and data info
• Follow guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems
• Secure needed medical documentation required or requested by third party insurance carriers
• Maintain and respect the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure
• Understand, follow, and maintain productivity and performance based role expectations
• Perform other related duties as required

Qualifications

• 2-3 years of medical collections, denials and appeals experience
• Experience with all but not limited to the following denials and appeals:
  • DRG downgrades
  • Level of care
  • Coding
  • Medical necessity
  • Experimental
  • Bundling
  • Noncovered
  • No authorization
• Intermediate knowledge of ICD-10, CPT, HCPCS and NCCI
• Intermediate knowledge of third-party billing guidelines
• Intermediate knowledge of billing claim forms (UB04/1500)
• Intermediate knowledge of payor contracts - commercial and government
• Intermediate working knowledge of Microsoft Word and Excel
• Intermediate knowledge of health information systems (i.e. EMR, Claim Scrubbers, Patient Accounting Systems, etc.)

Requirements

• Intermediate knowledge of one or more of the following Patient accounting systems: EPIC, Collections Management, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts or Paragon
• Intermediate knowledge of DDE Medicare claim system
• Intermediate knowledge of government rules and regulations

Benefits

• The salary range for this role is from $20.00 to $23.00, varying based on geographic location, candidate experience, applicable certifications, and skills.

Company Description

SAVISTA is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class.