Accounts Receivable Specialist

Job Summary

Responsible for all facets of medical billing and accounts receivable management including charge entry, payment posting, customer service and follow-up in accordance with practice protocol with an emphasis on maximizing patient satisfaction and profitability. Responsible for reviewing the patient demographic information in the practice management system at the time of charge entry to ensure accuracy and to provide feedback to the other front office staff regarding patient registration. Responsible for reviewing the physician’s coding at the time of charge entry to ensure accuracy, timely payments, and to maximize revenue. Responsible for submitting insurance claims as required by standard operating procedures. Responsible for providing cross coverage for the Authorization Coordinator, Receptionists as required to ensure efficient and professional practice operations and maximum patient satisfaction.

Duties and Responsibilities

• Input all charges into the practice management system including office and hospital charges in accordance with practice protocol with an emphasis on accuracy to ensure timely reimbursement and maximum patient satisfaction. All charge batches should balance in both number of procedures and total dollar prior to posting.

• Post all payments, by line-item, received for physician’s professional services into the practice management system including co-payments, insurance payments, and patient payments in accordance with practice protocol with an emphasis on accuracy to ensure maximum patient satisfaction and profitability. All payment batches must be balanced in both their dollar value of payments and adjustments prior to posting.

• Post all credit and debit adjustments to patient accounts with strict adherence to the guidelines in the Procedure Manual.

• File all charge, payment and adjustment batches in the appropriate format by batch date for quick reference.

• Review the physician’s coding at charge entry to ensure compliance with Medicare guidelines and to ensure accurate and timely reimbursement.

• Provide customer service both on the telephone and in the office for all patients and authorized representatives regarding patient accounts in accordance with practice protocol. Patient calls regarding accounts receivable should be returned within 1 business day to ensure maximum patient satisfaction.

• Verify all demographic and insurance information in patient registration of the practice management system at the time of charge entry to ensure accuracy, provide feedback to other front office staff members and to ensure timely reimbursement.

• Follow-up on all outstanding insurance claims at 60-days from the date of service in accordance with practice protocol with an emphasis on maximizing patient satisfaction and practice profitability.

• Follow-up on all outstanding patient account balances at 90-days from the date of service in accordance with practice protocol with an emphasis on maximizing patient satisfaction and practice profitability using the A/R aged reports.

• Provide information pertaining to billing, coding, managed care networks, insurance carriers and reimbursement to physicians, managers and subordinates.

• Follow-up on all returned claims, correspondence, denials, account reconciliations and rebills within five working days of receipt to achieve maximum reimbursement in a timely manner with an emphasis on patient satisfaction.

• Submit primary and secondary insurance claims electronically each day and on HCFA semi-weekly to ensure timely reimbursement.

• Attendance at relevant seminars to remain abreast of current issues regarding obstetric and/or gynecology accounts receivable, Medicare Compliance and HIPAA.

• Recommend accounts for outside collection when internal collection efforts fail in accordance with practice protocol.

• Process refunds to insurance companies and patients in accordance with practice protocol.

• Monitor reimbursement from managed care networks and insurance carriers to ensure reimbursement consistent with contract rates.

• Monitor the supply and quality of forms, envelopes and supplies as required to perform job functions.

• Proficiency with all facets of the medical practice management system including patient registration, charge entry, insurance processing, advanced collections, reports and ledger inquiry.

• Proficiency with verifying eligibility and claim status information, to efficiently conduct accounts receivable follow-up and to maximize revenue.

• Maintain information regarding coding, insurance carriers, managed care networks and credentialing in an organized easy to reference format.

• Maintain an organized, efficient and professional work environment.

• Adhere to all practice policies related to OSHA, HIPAA and Medicare Compliance.

• Other duties as assigned.

Knowledge, Skills and Abilities

Required

• Requires an extensive working knowledge of managed care networks and insurance carriers.
• Requires excellent written and verbal communication skills and strong customer service skills.
• Requires strong basic mathematical skills.
• Requires an extensive working knowledge of accounts receivable functions including CPT and ICD-9 coding.
• Requires proficiency in general office automation including operation of fax machines, copy machines, adding machines, postage machines, and multi-line phone systems.
• Requires proficiency in working with a PC, the Internet, and MS Windows.
• Requires a good understanding of the current Medicare Compliance, OSHA, and HIPAA regulations.
• Requires a high degree of organization.

Credentials and Experience

Required

• High school diploma or GED is required. A college degree is preferred.
• Requires a minimum of 3 years of accounts receivable experience preferably in a Federally Qualified Health Center (FQHC). Obstetrics and/or gynecology experience a plus.

Special Requirements

Requires full range of body motion including manual and finger dexterity and eye/hand coordination. Requires sitting, standing and walking for extensive periods of time. Requires working under stressful conditions or working irregular hours. Requires frequent exposure to communicable diseases, body fluids, toxic substances, medicinal preparations and other conditions common to a clinic environment. The employee frequently is required to reach with hands and arms. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. Ability to work with a moderate noise level in the work environment is required.

The above information is intended to describe the most important aspects of the job. It is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required in order to perform the work. The health center reserves the right to revise or change job duties and responsibilities as the business need arises. Additionally, this job description is not intended as an employment contract, implied or otherwise, and the Center continues to maintain its status as an at-will employer.

If the essential functions of this position cannot be performed in a satisfactory manner by the employee, reasonable accommodations may be made.