Accounts receivable specialist - hospitals

Job Details:

Job Location: Home Office - Oklahoma City, OK

Position Type: Full Time

Education Level: GED/High School

Salary Range: Undisclosed

Travel Percentage: None

Job Shift: Day

Job Category: Revenue Cycle - PFS

JOB PURPOSE:

The Accounts Receivable Specialist is primarily responsible for effective collection of patient accounts, accounts receivable follow-up, and reimbursement analysis for all non-government accounts to ensure timely and maximum reimbursement for client HOSPITALS.

ESSENTIAL FUNCTIONS INCLUDE BUT NOT LIMITED TO:

• Manage assigned accounts to ensure outstanding and pending claims are resolved and paid at maximum reimbursement in a timely manner.
• Request claim reprocessing when appropriate and prepare and submit corrected claims as needed.
• Conduct follow-up on all outstanding insurance claims beginning at 30 days from date of service.
• Review and resolve credit balance accounts, including payer and patient refund requests and misapplied payments or adjustments.
• Address returned claims, correspondence, denials, account reconciliations, and rebills within two working days of receipt.
• Identify and communicate denial trends to the Revenue Cycle Manager.
• Maintain working knowledge of insurance guidelines, including HMO, PPO, Medicare, and Medicaid.
• Demonstrate knowledge of institutional and professional billing requirements, including UB-04 (CMS-1450) and CMS-1500 claim forms.
• Obtain necessary documentation or clarification from facilities to resolve claims.
• Ensure compliance with state and federal regulations, payer guidelines, and company policies and procedures.
• Assist in developing, implementing, and improving revenue cycle processes.
• Maintain strict confidentiality of patient and financial information.
• Support management with special projects and perform other duties as assigned.

BEHAVIORAL STANDARDS:

The individual must support the mission, vision, and goals of Avem Health Partners and serve as a role model within the company. Exhibit positive customer service behavior in everyday work interactions. Demonstrate a courteous and respectful attitude to internal workforce and external customers. Communicate accurately and appropriately. Handle difficult situations in a discreet and professional manner. Hold self-accountable for professional practice. Demonstrate knowledge of unit goals and is active in committees and projects to achieve these goals. Keep current with literature regarding changing practices, interventions, and best practices in patient care. Assume responsibility for seeking out educational and professional opportunities for personal learning needs and growth as well as meeting mandatory education requirements. Act as a preceptor as requested. Demonstrate excellent work attendance and attend and actively participate in a variety of meetings and training sessions as required. Adhere to the Avem Health Partners Code of Conduct and Standards of Behavior. Complies with established policies and procedures and all health and safety requirements.

EDUCATION:

High school diploma or equivalent

At least two years of medical accounts receivable experience

CERTIFICATION/LICENSURE:

Medical billing certification, if available.

PHYSICAL REQUIREMENTS:

To perform this job successfully, an individual must be able to perform each essential job duties satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant to be considered. This job requires visual abilities, auditory abilities, must be intact to perform duties.