AR Follow Up/Denials

5 hours ago

Quezon City, National Capital Region, Philippines Tenet Global Business Center, Inc. Full time ₱400,000 - ₱600,000 per year

The AR Follow-up/Denials is responsible for working accounts to ensure they are resolved in a timely manner. This candidate should have a solid understanding of the Revenue Cycle as it relates to the entire life of a patient account from creation to payment. Representative will need to effectively follow-up on claim submission, remittance review for insurance collections, create and pursue disputed balances from both government and non-government entities. Basic knowledge of Commercial, Managed Care, Medicare and Medicaid insurance is preferable. An effective revenue cycle process is achieved with working as part of a dynamic team and the ability to adapt and grow in an environment where work assignments may change frequently while resolving accounts with minimal assistance.

Responsibilities and Duties

  • Perform duties as assigned in a professional demeanor, which includes interacting with insurance plans, patients, physicians, attorneys and team members as needed.
  • Basic computer skills to navigate through the various system applications provided for additional resources in determining account actions.
  • Access payer websites and discern pertinent data to resolve accounts.
  • Utilize all available job aids provided for appropriateness in Patient Accounting processes.
  • Maintain department daily productivity goals in completing a set number of accounts while also meeting quality standards as determined by leadership.
  • Identify and communicate any issues including system access, payor behavior, account work-flow inconsistencies or any other insurance collection opportunities.
  • Provide support for team members that may be absent or backlogged.
  • Processes accounts and works with designated payors to resolve outstanding balances.
  • Perform corrective actions required to resolve the account using the appropriate resources and applications.
  • Responsible for managing and collecting outstanding accounts receivable balances for the company.
  • Work with payer to resolve outstanding balances.
  • Communicate with internal departments to resolve billing discrepancies.
  • Maintain accurate and up-to-date records of all collections activity.

  • Will work on Appeal Follow Up:

  • Low Dollar Buckets - G %

  • High Dollar Bucket %
  • Produces claims at 100% and up

Functional Area Outcomes and Expectations

  • To successfully perform medical billing job through taking and completing each essential duty satisfactorily.
  • Proficiency in utilizing ACE and the editors.
  • Ensuring compliance with HIPAA and other medical insurance guidelines

Knowledge, Skills, and Abilities

  • Able to learn to be an effective user of the practice management system.
  • Adhere to company processes, procedures, and policies.
  • Ensuring compliance with HIPAA and other medical insurance guidelines.

Required and Preferred Qualifications

  • Has at least 1-2 years of healthcare experience
  • 3 years medical claims and/or AR Management experience, payment posting/reconciliation is a plus
  • Minimum typing requirement of 45 wpm

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