AR Specialist 3
Here at Savista, we enable our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results. We partner with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities, all while living our values of Commitment, Authenticity, Respect and Excellence (CARE).
Job Description
The Medical Insurance Accounts Receivable Representative is responsible for ensuring the timely collection of outstanding government or commercial healthcare insurance receivables.
Responsibilities:
- Verifies or obtains patient eligibility and/or authorization for healthcare services performed by searching payer web sites or client eligibility systems, or by conducting phone conversations with the insurance carrier or healthcare providers.
- Updates patient demographics and/or insurance information in appropriate systems.
- Conducts research and appropriately statuses unpaid or denied claims.
- Monitors claims for missing information, authorization and control numbers (ICN//DCN).
- Researches EOBs for payments or adjustments to resolve claims.
- Contacts payers by phone or through written correspondence to secure payment of claims.
- Accesses client systems for information regarding received payments, open claims and other data necessary to resolve claims.
- Follows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems.
- Secures medical documentation as required or requested by third party insurance carriers.
- Obtains billing guidelines and requirements by researching provider billing manuals.
- Writes appeal letters for technical appeals.
- Verifies accuracy of underpayments by researching contracts and claims data.
- In the event of an authorization, coding, level of care and/or length of stay denial, prepares claims for clinical audit processing.
- Supports nThrive’s Compliance Program by adhering to policies and procedures pertaining to HIPAA, FDCPA, FCRA, and other laws applicable to nThrive’s business practices. This includes: becoming familiar with nThrive’s Code of Ethics, attending training as required, notifying management or nThrive’s Helpline when there is a compliance concern or incident, HIPAA-compliant handling of patient information, and demonstrable awareness of confidentiality obligations.
- Train New Colleagues
- Assist with Chairside Training of Current Colleagues
- Approve Adjustments
- Identify Issues and Trends with Payors
- Lead Daily FUNA huddles
- Work Special Projects as assigned by leadership
Requirements:
- High school diploma or GED.
- At least 3 years of experience in healthcare insurance accounts receivable follow up, working with or for a hospital/hospital system, working directly with Medicare, Medical, TPL or commercial insurance payers.
- Experience identifying billing errors and resubmitting claims as well as following up on payment errors, low reimbursement and denials.
- Experience reviewing EOB and UB-04 forms to conduct A/R activities.
- Knowledge of accounts receivable practices, medical business office procedures, coordination of benefit rules and denial overturns and third-party payer billing and reimbursement procedures and practices.
- At least two years of experience with accounts receivable software.
- Experience navigating payer sites for appeals/reconsiderations, benefits verification and online claims follow up.
- Demonstrated ability to navigate Internet Explorer and Microsoft Office, including the ability to input and sort data in Microsoft Excel and use company email and calendar tools.
- Demonstrated success working both individually and in a team environment.
- Demonstrated experience communicating effectively with payers, understanding complex information and accurately documenting the encounter.
- Ability to work effectively with cross-functional teams to achieve goals.
- Demonstrated ability to meet performance objectives.
Preferred Skills:
- Experience with Epic, Meditech, Cerner, Invision, Paragon, Soarian, Collections Management or STAR.
- Experience working with or for a hospital/hospital system with more than 250 beds.
- Experience with both hospital (facility) and physician (pro-fee) A/R.
Each colleague is encouraged, but not required, to discuss their plans to seek another opportunity within the Company with their current supervisor. Colleagues may also, if they choose, contact Talent Acquisition to learn more about the details of the opportunity prior to speaking with their manager or applying. In addition, before submitting an application, the colleague should ensure that they remain in good standing in their current role.
Note: Savista is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $13.13 to $20.63. However, specific compensation for the role will vary within the above range based on many factors including but not limited to geographic location, candidate experience, applicable certifications, and skills.
SAVISTA is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class.