Overview: We are seeking an experienced and detail-oriented Accounts Receivable Specialist to join our central billing office team for ambulatory surgery centers. The successful candidate will play a crucial role in resolving outstanding surgical claims resulting in maximum reimbursement.Responsibilities:
- Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers including self-pay to obtain maximum reimbursement.
- Prioritize high dollar claim balances through work queues
- Review & work incoming insurance and patient correspondence including refund requests.
- Send appeals when appropriate or provide the requested medical documentation.
- Ability to review medical documentation to justify medical necessity.
- Review patient balances to ensure accuracy and follow up with patients to obtain payments.
- Take incoming patient phone calls to resolve inquiries, billing issues, or outstanding balances.
- Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents.
- Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD's) for claim resolution.
- Negotiate payment amounts for procedures with Third Party Administrators for out of network providers.
- Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.
Requirements
- 2+ years of ASC revenue cycle OR orthopedic collections experience is preferred.
- Strong understanding of medical billing and insurance reimbursement processes, including experience with denials and appeals.
- Ability to read and interpret insurance explanations of benefits and managed care contracts.
- Excellent interpersonal and communication skills.
- Must be able to multi-task and handle competing priorities while meeting or exceeding deadlines.
- Intermediate computer proficiency in Microsoft Office including Excel and Outlook.
- Advantx, Vision, HST, SIS Complete, or Waystar experience preferred.
- High School Diploma or equivalent is required.