Accounts Receivable Specialist

Job Details

Level: Experienced

Job Location: Portland, OR

Salary Range: $20.00 - $28.00 Hourly

Description

At WHA, we're a team, passionate about humanizing healthcare. We're inspired by the diverse stories, strength and resilience of our patients and the unique choices they make in pursuing health for themselves and their families. We envision a world where every person has the opportunity to achieve their optimal health and we're here to support that journey with personalized, culturally competent care and knowledge.

The Accounts Receivable Specialist ensures accurate, compliant, and timely billing and appropriate reimbursement for all inpatient, outpatient and professional medical service from all payers for service rendered by WHA. This may include accurate and timely identification and completion of registration, billing, adjustments, follow-up, and collection of unpaid accounts.

Duties

• Researches and corrects all denials received for designated insurance companies and discipline. Identifies trends in claim denials by insurance and efficiently solves the problem using available resources to ensure proper payment.
• Assists patients (primarily via telephone) by answering questions about insurance denials, claim processing, benefit applications, explanation of benefits (EOBs) and other necessary information for patient billing.
• Reviews and follows up on pending and denied claims within the work queue with insurance companies in a scheduled and timely manner.
• Reviews daily correspondence batches to respond to correspondence received from insurance companies. Sends insurance companies additional information for proper claims processing as necessary.
• Monitors turnaround time for medical records, corrected claims, and EOBs that require more information.
• Works with insurance provider representatives as needed for claims reprocessing.
• Writes appeal and reconsideration letters to insurance companies as needed. Utilizes insurance websites or electronic appeal processes, when possible, to expedite insurance turnaround time.
• Works with internal customers (such as remissions, patient services staff, coders, contract negotiators, etc.) to identify, monitor, and/or improve insurance-related issues.
• Updates patient registration and insurance information as requested by patient. Identifies missing registration information and utilizes all resources including hospital databases and insurance websites. Resubmits claims electronically to updated insurance as needed.
• Performs audits to identify and resolve account credit balances. Prepares account with required documentation for Accounts Payable to process refund to insurance or patient, or by having insurance recoup payment.
• Compiles complete documentation for each adjustment to be filed in batch, such as EOB's, encounter forms, account inquiry, etc.
• Documents all correspondence and conversations with patients and insurance carriers into patient's account per established guidelines.
• Obtain retro prior authorizations and referrals from insurance companies as needed to assist with denials or payments of claims.
• Work directly with clinics to obtain documentation necessary for claim filing (OHP Consent forms) and file QI tickets when that documentation was not completed correctly.
• Work insurance medical records requests by obtaining medical records documentation and submitting to insurance for claim processing.
  
  

Qualifications

QUALIFICATIONS

• High school diploma or GED required.
• Experience in medical billing and collections required, preferably in an OB/GYN clinic.
• 2 years' experience in accounts receivable.
• Experience with or ability to learn Microsoft Windows-based computer and medical practice management billing software.
• Epic experience preferred.
  
  

Salary Range/Equity Pay Analysis: Please note per the Oregon State Pay Equity Law your salary is determined based on the experience and education listed in your resume/application. It is strongly encouraged to include any transferable experience to ensure your offer is reflective of all directly related and equivalent experience. Please be specific with dates of positions, skills, and educational experiences related to the job you are applying for within your application materials.

WHA is 2023's #1 Largest Women-Owned Business in Oregon and Clark and Skamania Counties from the Washington-Portland Business Journal.

Women's Healthcare Associates, LLC is an equal opportunity employer.

Required

Oregon employers are required by a number of state and federal agencies to display a variety of workplace notices and posters, including:

Federal Family and Medical Leave Act

https://www.dol.gov/whd/regs/compliance/posters/fmlaen.pdf

Oregon Family Leave Act

www.oregon.gov/boli/TA/docs/oflaposter2016englishlarge.pdf