Medical Claims AR Specialist
3 weeks ago
The AR Specialist III is responsible for post-payment and account follow-up and/or grievance preparation of assigned client accounts receivable. Working at a client site or in a centralized location, responsibilities may include account maintenance of specialized or multiple payers including state and federal government programs, managed care, commercial and other insurance groups. This role may also serve as a liaison to clinical auditors, other team members, client staff, government agencies and health plans to facilitate the appropriate and prompt payment of claims.
Duties & Responsibilities:
-Verify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the insurance carrier/providers
-Update patient demographics/insurance information in appropriate systems Research/ Status unpaid or denied claims
-Monitor claims for missing information, authorization, and control numbers (ICN//DCN)
-Research EOBs for payments or adjustments to resolve claim
-Contacts payers via phone or written correspondence to secure payment of claims Access client systems for payment, patient, claim and data info
-Follows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems
-Secure needed medical documentation required or requested by third party insurance carriers.
-Maintain confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure
-Perform other related duties as required
-Utilize provider billing manuals to obtain billing guidelines and requirements.
-Write appeal letters for technical appeals
-Verifies accuracy of underpayments utilizing contracts and claims data.
-Prepares claims for clinical audit processing in the case of authorization, coding, level of care and/or length of stay denials
-Utilizes reports for analysis and to monitor follow up activities and prioritization
-Assists organization with working through special projects as needed
-SME for colleagues and provide direction for resolution of accounts
-Assists in new hire training
-Assists in content building of training materials
Qualifications & Competencies:
-3+ years of medical collections/billing experience
-Intermediate knowledge of ICD-10, CPT, HCPCS and NCCI
-Expert knowledge of third-party billing guidelines
-Expert knowledge of billing claim forms (UB04/1500)
-Expert knowledge of payor contracts
-Working Knowledge of Microsoft Word and Excel
-Intermediate working knowledge of health information systems (i.e., EMR, Claim Scrubbers, Patient Accounting Systems, etc.)
Preferred Qualifications:
-Working knowledge of one or more of the following Patient accounting systems – EPIC, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts or Paragon
-Prior team lead experience
-Working knowledge of DDE Medicare claim system
-Knowledge of government rules and regulations
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