Specialist, CBO Accounts Receivable Insurance

Full-Time AR Insurance Specialist (Remote Position)

JOB REQUIREMENTS

• Ability to read, comprehend, and decipher explanations of benefits (EOBs) from various insurance carriers.
• Working knowledge of medical terminologies, such as CPT and ICD10 codes.
• Strong background in claims processing and filing insurance appeals and disputes.
• The primary point of contact with health insurance providers/systems and healthcare clients/systems.
• Ability to utilize payer’s websites/portals to determine insurance guidelines, claim status, or eligibility criteria.
• Experienced in authorization denials and follow-ups.
• Ability to utilize multiple systems/platforms to conduct research and analysis.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Performs insurance follow up on unpaid claims utilizing payer website and/or AVR. Assigned claims should be completed thoroughly to include the action taken to have corrected claim reprocessed or appealed.
• When assigned accounts receivable reports; work and complete them in accordance with the work instructions provided. Email the supervisor if unable to meet the timeframe.
• Meet productivity standards:
  • Follow Up and Denial reps should maintain a daily average of 50 claims (minimum) per day on Managed Care, Medicare & Medicaid, and all other payers.
  • Medical records reps should maintain a (minimum) daily average of 30 claims
• Escalate claims to the correct coding contacts for corrections to be made by the coders with appropriate details of what needs to be reviewed.
• Responsible for forwarding and providing updated information to Supervisor.
• Must know the client specialties, locations, and proper A/R information.
• Communicate claim trends resulting in denials or a decrease in payments. This information is to be sent to management with the payer, provider(s), number of claims and dollar amount affected.
• Keeps management informed of client problems on communication and correspondence.
• A new employee must be able to meet the established and agreed upon goals within 90 days of continuous employment.
• Must have the ability to concentrate for extended periods of time.

JOB SPECIFICATIONS

• A high school diploma or equivalent is required.
• Prior relevant work experience in AR/Medicaid/Commercial health insurance processes.
• Demonstrated customer service experience and/or experience in a customer service-oriented environment.
• Strong customer service orientation with demonstrated commitment to meet/exceed customer needs.
• Ability to maintain reliable and predictable attendance.
• Strong verbal/written communication and interpersonal skills.
• Demonstrated ability to work in a fast-paced, structured environment, handling large call volumes.
• Computer proficiency is essential.
• Self-directed with the ability to perform both as part of a team and individually.
• Ability to adapt and work effectively in a continuously changing environment.
• Consistently demonstrate a high level of professionalism through a strong work ethic that positively influences the work habits of the team.
• Detail-oriented with a focus on quality and consistently meeting goals.

TOOLS AND TECHNOLOGY

Must be able to multi-task. Utilize computer, copier, fax and phones. Be able to navigate through shared drives.

QUALIFICATIONS

To perform this job successfully the incumbent must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

EDUCATION and/or EXPERIENCE

A high school diploma is required; Medical Coding degree/certificate or an Associate degree is preferred. Two to three years of related experience and/or training; or an equivalent combination of education and experience.

LANGUAGE SKILLS

The position requires the ability to read and comprehend basic instructions, general correspondence, and memos. In addition, the ability to write office correspondence, effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization are required.

MATHEMATICAL SKILLS

Ability to add, subtract, multiply and divide into all units of measure, using whole numbers, common fractions, and decimals.

REASONING ABILITY

The incumbent will be expected to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Also, should have the ability to deal with problems involving several concrete variables in standardized situations. Will be expected to learn and comprehend basic physician billing/AR management terminology and protocols to effectively function within the position’s scope of responsibilities.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms, and talk or hear. Specific vision abilities required by this job include the ability to adjust focus.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. The noise level in the work environment is usually moderate.