Pro Fee Accounts Receivable Specialist
Three (3) years Professional Fee billing experience required
Under general supervision, evaluates financial responsibility of patients, updates accounts to a billable/collectible status, research all possible means to resolve accounts, contacts patients, insurance companies and other departments regarding financial reimbursement. Organizes collection procedures in accordance with current laws, serves as appropriator of patient accounts and prioritizes multiple collection tasks with the main objective to reduce uncompensated care.
Principal Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
Responsible for defined accounts receivable. Accountable for reduction of Accounts Receivable equal to goals set by senior management.
Works with third party insurance and payer contracting department to obtain maximum level of cash to reduce receivable. Follows up with insurers to recover inaccurate payments.
Reviews accounts to ensure accuracy of billing/charging utilizing knowledge of pre-certification /prior authorization procedures to validate account status. Resolves any problems with billing or handling of accounts.
Handles patient concerns with professionalism and excellent customer service skills. Relays any patient suggestions and complaints to immediate supervisor for consideration. Provides answers for patient’s questions in a reasonable response time.
Follows departmental guidelines for handling delinquent accounts receivable.
Utilizes compassionate care program appropriately.
Researches all avenues of funding for patients who exhibit financial need.
Works with the Medical Assistance Eligibility team to refer patients through the Medical Assistance process.
Gathers and records data for the purpose of enhancing and perfecting collection procedures.
Shares information with the team to improve the integrity of data.
Shares information with administrator to solve existing problems with systems or data and effectively promotes avoidance of future problems.
Effectively updates and/or views data in all accessible systems.
Assists supervisor with new staff training
Accommodates all visitors with accurate information and professionalism.
Performs appeals process when appropriate.
Promotes accuracy among all accounts by thoroughly reviewing all transactions
Maintains a thorough understanding of financial references, including guidelines for reimbursement, state and federal regulations, payor-specific reimbursement policies, procedures and resource material references.
Notifies supervisor of problem accounts which may lead to significant financial loss.
Utilizes appropriate letters as necessary to promote communication to patients and insurers on a large scale
Works self pay Accounts Receivable, updating patient accounts with documentation of follow up activity, new demographic or insurance information on the patient account and in the production log within Resolute. Liaison with outside collection vendors. Handles all incoming and outgoing patient correspondence.
Education and Experience
High School Diploma or equivalent (GED) is required. Associate’s Degree preferred.
Three (3) years Professional Fee billing experience required.
Knowledge, Skills and Abilities
1. Knowledge of collection laws, medical coding (CPT & ICD-9/10) and third party billing guidelines including timely filing limitations and Medical terminology preferred.
2. Develops knowledge of current collection laws.3. Demonstrated ability to perform mathematical calculations.
4. Demonstrated proactive problem-solving skills. Ability to interpret data and related information and discern trends, tendencies as well as determines appropriate course of action.
5. Demonstrated ability to use PC applications such as spreadsheets and word processing
6. Highly effective oral and written communication skills are necessary in order to communicate effectively with clinicians, patients and insurance companies.
7. Ability to meet quality performance standards.
8. Ability to maintain a culture of excellent customer service, open and friendly staff relations with associates of all levels.