Accounts Receivable Specialist FT (Credit Balance Emphasis)

UCI Medical Affiliates, Inc. (UCI) provides non-medical management and administrative services to over 50 Doctors Care urgent care centers and 24 Progressive Physical Therapy facilities located throughout South Carolina. UCI is headquartered in Columbia, South Carolina. Doctors Care has operated for over 30 years, providing an exceptional, convenient, and affordable healthcare experience.

UCI is currently looking for an Accounts Receivable Specialist to join our team. The position works to resolve outstanding, unpaid, unprocessed, and denied claims submitted to third-party payers on behalf of Progressive Physical Therapy providers, to ensure compensation is received fully, and in a timely manner. Accesses third-party websites, places outbound phone calls, accepts inbound phone calls, sends and receives facsimiles and sends and receives correspondence with third-party payers and various government agencies for follow-up on non-responsive claims and denials for payments. The position reports to the Accounts Receivable Supervisor.

• Applies knowledge related to interpreting explanation of benefits and regulations concerning coordination of benefits and other applicable guidelines. This includes being able to assess that reimbursement, allowances, and patient payments received are applied correctly.
• Resolves accounts by various methods that includes making adjustments, transferring funds, corresponding with necessary contacts, responding to inquiries, utilizing various tools for addressing discrepancies and initiating recoupment requests, and processing refunds, all in accordance and in compliance with company, state and federal policies, regulations and procedures.
• Makes corrections on credit balance accounts as necessary.
• Follows up on self-pay/patient refunds as needed.
• Monitors, manages and resolves unapplied and unassigned payments/credits in the patient credit workbaskets.
• Reviews, researches and resolves insurance claims, unprocessed third party claims, denials, underpayments and overpayments.
• Verifies accuracy of billing data and corrects errors; resubmits clean claims to payers electronically or via paper claim.
• Works, monitors and manages his/her respective workbaskets including, but not limited to, denials, 60 Day, 90 Day, 120 Day, and 150 Day aging on assigned insurance carrier(s) to get claims paid in a timely manner.
• Works incoming mail and EOBs (Explanation of Benefits) from the insurance carriers and processes claims related correspondence to resolve issues.
• Works EDI transactions, ERA files and rejection reports.
• Contacts payers via phone to help expedite the resolution of claims and payments.
• Accesses web-based applications and internet for claim status and eligibility of services.
• Identifies and resolves patient billing complaints and inquires. Assists the overflow customer service line when volume of incoming calls warrants assistance.
• Complies with Patient Accounting quality and productivity standards.
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Other duties and responsibilities as assigned by supervisor.