The Accounts Receivable (AR) Specialist will work with the Inpatient, Physician and specialty billing team and support all claim and variance review of all client Accounts Receivables. Implements appropriate billing and collection procedures, ensuring that the inpatient and outpatient accounts receivable system records are kept in accordance with established procedures. Performs the inpatient and outpatient billing, and collections operations. Implements controls to ensure appropriate submission, billing, and payment cycles. Reinforces procedures for follow up on third party approvals, billing, and collection on overdue accounts. Exceeds NPSR goals on a monthly/quarterly and annual basis. Answers all inquiries from patients or responsible parties regarding their accounts. Performs all other duties assigned by the VP of Revenue Cycle for The Chappelle Group or his/her assignee.
Essential Functions & Responsibilities:
- Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites.
- Working knowledge of the insurance follow-up process with understanding of the fundamental concepts in healthcare reimbursement methodologies
- Detailed knowledge of Managed Care reimbursement methodologies
- Perform payment variance analysis to identify trends in underpaid claims
- Perform special projects and other duties as needed. Assists with special projects by utilizing excel spreadsheets, and the ability to communicate results.
- Identify and report underpayments and denial trends
- Initiate appeals when necessary
- Basic knowledge of healthcare claims processing including: ICD-9, CPT, and HCPC codes, as well as UB-04
- Ability to analyze, identify and resolve issues causing payer payment delays
- Act cooperatively and courteously with patients, visitors, co-workers, management and clients.
- Maintain confidentiality at all times
- Maintain a professional attitude
- Understand and comply with Information Security and HIPAA policies and procedures at all times
- Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
- Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties
- Report any security or HIPAA violations or concerns to the HIPAA Officers in a timely fashion
The incumbent performs duties in accordance with performance standards set forth by TCG and the customer. The incumbent may have access to highly confidential customer, patient, employee, and TCG proprietary information, and must handle and protect the information in accordance with institutional and system policies, HIPAA requirements, and with the highest level of ethical standards. The incumbent is responsible for reporting all security events, potential events, and other security risks to the organization. The incumbent is accountable for employee safety and will attend safety and loss-control training, engage in injury prevention, perform accident and injury investigations including conducting root cause analysis and assist in returning employees to regular duty. The incumbent is responsible for participating in and completing all patient safety initiatives appropriate to the position and conducts all job responsibilities according to the Mission and Values of TCG and the customer.