Job Description
Job Description
Quadris Team, LLC - A Revenue Cycle Management Group, is searching for that dynamic person to join us, working with our highly skilled Physician AR Specialist Team Team to fill the role of Accounts Receivable Specialist with an emphasis on initial billing. We are a 100% remote team supporting our clients across the United States! See us at www.quadristeam.com
We are looking for high performing, passionate and results driven team members to join our group.
Job FOCUS :
This position is responsible for Initial Billing, Re-Billing, Post-payment and Account Follow-up and / or grievance preparation of assigned Client EMR Accounts Receivable. The responsibilities may include account maintenance of specialized or multiple payers including state and federal government programs, managed care, commercial and other insurance groups. Partners with other team members and health plans to facilitate the appropriate and prompt payment of claims. This individual must demonstrate a commitment to the organization's strategic plans, short and long-term goals and mission, vision and values by representing the company in a caring and professional manner.
Primary / Essential Expectations For Success :
The Primary responsibilities and essential job duties effectively and efficiently performed include but are not limited to the following :
BILLING
- Responsible for initial billing management using industry standard coding modifiers, DRG coding, etc., as needed
- Reviews and / or scrubs final billed initial claims for accuracy and completeness prior to submitting to payer
- Calculates Tier, Outlier, DRG and / or other Fee Schedule based reimbursement
- Submits electronic and / or hard copy claims with any attachments as per the contract timely filing criteria
- Documents all account activity in the hospital system and The Q with clear and concise notes
INSURANCE FOLLOW-UP
Within appropriate timeframes, contact the health plan by phone or website to determine status of claimDocuments all follow-up actions in the hospital account notes and database and sets up account for additional review based on client expectations for follow-up of unresolved accountsPOST PAYMENT REVIEW
Researches and validates the paid or partially paid claim status is in accordance with the expectations outlined in the client contract agreementDeliberately and thoroughly reviews any denied, dis-allowed, or non-covered claims / charges and determines accuracy based on contract languageResolves any technical issues when warranted with payerFollows client specific procedures to request adjustments and refundsPrepares appeal and necessary documentation for authorization, coding, level of care and / or length of stay denialsFollow guidelines for prioritization and timely filing deadlinesPhysical / Mental Demands, Environment :
Prolonged periods of sitting at a desk and working on a computerMust be able to lift 15 pounds at one timeMust be able to structure your home office to ensure patient information is secure meeting the regulatory expectationsSkills Needed to Be Successful :
Maintains compliance with regulations and laws applicable to jobProfessional level of communication with video, phone and emailAbility to effectively prioritize the work to meet deadlines and expectationsMeets the quality and productivity measures as outlined by QuadrisBrings positive energy to workUses critical thinking skillsBeing present and focused on assigned tasks and eliminates distractionsBeing a self-starterAbility to work independently and within a team atmosphereCore Talent Essentials :
High School diploma or equivalent2 years previous experience in healthcare revenue cycle managementPrefer 2 years experience with initial biller structureAbility to work independently and within a team atmosphereAdvanced proficiency of CPT and ICD-10, and full-scope revenue cycle management frameworkSelf-motivated and passionate about our mission and values of quality workMust have professional level skills in MS products such as Excel, Word, Power Point.Proficient application of business / office standard processes and technical applicationsCertifications :
Active AAPC or AHIMA coding certificateActive national certification CRCR through Healthcare Finance Management Organization (HFMA), or can test successfully for the certification within 9 months from hire date
