AR Specialist

4 months ago

Pasig City, Philippines Visaya KPO Full time

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).  Research 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 Savista’s Compliance Program by adhering to policies and procedures pertaining to HIPAA, FDCPA, FCRA, and other laws applicable to Savista’s business practices. This includes: becoming familiar with Savista’s Code of Ethics, attending training as required, notifying management or Savista’s Helpline when there is a compliance concern or incident, HIPAA-compliant handling of patient information, and demonstrable awareness of confidentiality obligations.

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