What are the responsibilities and job description for the Revenue Cycle AR Specialist I Per Diem position at Connecticut Children's?
Job Description
Position Summary
The Revenue Cycle AR Specialist I is responsible for resolving insurance balances, following up with payors, and submitting appeals and reconsideration requests on rejected and denied claims.
Responsible for ensuring claims are paid by insurance carrier to the organization correctly.
Works receivable inventory within department standards including, as applicable : maintaining assigned work list of hospital or professional accounts; documenting agreement arrangements or reasons for outstanding balances; performs collection & follow up efforts; coordinating and / or posting adjustments, contractual allowances, or refunds within levels of authority.
Responsibilities
Responsibility % of Time Accurately and compliantly resolves insurance balances after payment or adjudication, and correctly identifies any patient liability (i.e., contractual / payment review, etc.) and ensures accurate resolution of account to payment or payor terms; Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites. 20% Leverages available resources and systems (both internal and external) to analyze patient accounting information and take appropriate action for payment resolution; documents all activity in accordance with organization and payor policies. 20%
Coordinate appeal when claim is denied. May partner with medical care team members on complex appeals.
Submits LOMN (Letter of Medical Necessity) and other drafted appeals and reconsiderations on rejected and denied claims.
Sends appeals to payors, and follow up to ensure payment is made.
Continue to review acct and escalate as necessary if denial is not overturned.
20% Engages the CFC, UR, Revenue integrity or coding follow-up team for any medical necessity, auth. or coding related denials review. 20% Sets follow-up activities based on status of the claim; ensure full and clear account documentation on account status within system 10% Collaborate as a part of a team on special projects by utilizing excel spreadsheets, and effectively communicate results 10% Performs other job-related duties as assigned
Qualifications
Requirements
Required Preferred
Education :
High School Diploma, GED, or a higher level of education that would require the completion of high school
Education :
Associate's Degree in Healthcare Management, Finance, or related field
Experience :
Minimum 1 year completed experience in a Healthcare Revenue Cycle role
Experience :
Experience with Epic
Patient billing experience preferred
License / Certification / Registration :
n / a
License / Certification / Registration :
n / a
Knowledge, Skills, and Abilities
- Knowledge of billing and revenue cycle functions
- Basic knowledge of diagnosis and procedure codes, general medical terminology, and disability duration guidelines
- Knowledge of coverage criteria guidelines for insurance coverage as well as insurance verification process
- Solid knowledge of Microsoft office suite specifically MS word and Excel
- Effective written and verbal communication skills
- Able to prioritize work and adapt to new workflows and processes
- Able to work as part of a team
About Us
Connecticut Children's is the only health system in Connecticut that is 100% dedicated to children. Established on a legacy that spans more than 100 years, Connecticut Children's offers personalized medical care in more than 30 pediatric specialties across Connecticut and in two other states. Our transformational growth establishes us as a destination for specialized medicine and enables us to reach more children in locations that are closer to home. Our breakthrough research, superior education and training, innovative community partnerships, and commitment to diversity, equity and inclusion provide a welcoming and inspiring environment for our patients, families and team members.
At Connecticut Children's, treating children isn't just our job - it's our passion. As a leading children's health system experiencing steady growth, we're excited to expand our team with exceptional team members who share our vision of transforming children's health and well-being as one team.
