Overview of Position
A/R Specialist is responsible for calling all insurance companies and utilizing online resources to check claim status, resubmit claims as necessary via paper or electronically, file appeals, track denial trending, resolve denials, and ensure maximum revenue capture. In addition, this role will facilitate timely receipt of payments and ensure balances on accounts are correct and appropriately prorated.
Job Duties and Expected Performances:
· Identify the root cause of insurance denials, send appeals to payors, and take appropriate actions to assure prompt payment.
· Review encounters via NextGen, reports, and other sources with an average productivity of 50 accounts per day.
· Document follow-up appropriately in the practice management system.
· Maintain an acceptable error rate and productivity level within department policy.
· Perform collection actions, including third-party appeals and resubmitting claims to third party payers.
· Identify and bill secondary or tertiary insurances.
· Reconcile carrier submissions, edits, and rejection reports.
· Resolve incoming patient calls with excellent customer service skills.
· Employ tactfulness in dealing with insurance companies/patients regarding accounts in verbal and written communication, while being professional and courteous at all times.
· Identify, verify, and document adjustments according to established policies and procedures.
· Research and prepare credits for refund approval.
· Performs all other duties as assigned by direct report.
· High School Graduate or General Education Degree (GED)
· Associates degree
· Three years of professional medical billing and collecting experience, or certification obtained from a nationally accredited billing program, i.e., CMBS (Certified Medical Billing Specialist). Required
· One year of patient collection experience
· Experience with Excel and Windows-based programs.
· Experience in performing tasks that require a basic understanding of accounting and math skills.
· + Experience NextGen PM/EHR
· + One year of Optometry and Ophthalmology third-party billing guidelines and expertise.