Job Purpose

The Accounts Receivable Representative is responsible for collections, account follow up, billing and allowance posting for the accounts assigned to them.

Duties and Responsibilities

• Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites
• Meets and maintains daily productivity/quality standards established in departmental policies
• Meets and maintains quality standards established in departmental policies
• Uses the workflow system, client host system and other tools available to them to collect payments and resolve accounts
• Adheres to the policies and procedures established for the client/team
• Knowledge of timely filing deadlines for each designated payer
• Initiate appeals when necessary
• Ability to identify and correct medical billing errors
• Send appropriate appeals, accurate requesting information, supporting documentation, and effective communication to complete recovery process
• Ability to analyze, identify and resolve issues causing payer payment delays
• Ability to analyze, identify and trend claims issues to proactively reduce denials
• Understanding of under payments and credit balance process
• Perform special projects and other duties as needed. Assists with special projects by utilizing excel spreadsheets, and the ability to communicate results
• Act cooperatively and courteously with patients, visitors, co-workers, management and clients
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
• Work independently from assigned work queues
• Maintain confidentiality at all times
• Maintain a professional attitude
• Other duties as assigned by the management team

Qualifications

• 2 years’ experience in insurance collections, including submitting and following up on claims for a Medical Practice, Medical Facility/Medical Billing Company, Ambulatory Surgical Center, and/or Hospital
• Physician/Professional Billing: 1 year
• Knowledge of the denied claims and appeals process
• Knowledge of Worker’s Comp and PIP preferred
• Extensive knowledge of individual payor websites, including Navinet and Novitasphere
• Knowledge of Medical Terminology, CPT Codes, Modifiers and Diagnosis Codes
• Ability to work well individually and in a team environment
• Proficiency with MS Office. Must have basic Excel skillset
• Experience with practice management systems. EPIC PB, Allscripts and/or Cerner preferred
• Strong communication skills/oral and written
• Strong organizational skills

Working Conditions

• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.