Medical AR Collections Specialist

About the position The Medical AR Collections role will be responsible for medical billing of company specific IV and oral therapies on CPT+ platform. Daily functions require working knowledge of HCPC coding, ICD-10, JCodes, and CPT codes as well as experience interacting with Medicare, Medicaid, and Commercial insurances. Individual must be able to perform the essential functions of this position as listed below.

Responsibilities

• Follow up on all unpaid claims and aging A/R items, working directly with the insurance company, healthcare provider, and patient to get a claim processed and paid
• Research all denials and complete claim corrections, resubmissions, and adjustments accurately and timely as necessary. Must have a high ability to deal with complex claim issues.
• Verify that payments received are correct and according to payer fee schedules and company contractual agreements. Proficient at reading and interpreting EOBs and all forms of payer/insurance correspondence for both Pharmacy and Medical claims.
• Assign appropriate status to claims in Pharmacy processing system to ensure appropriate handling by appropriate RCM team personnel; make necessary demographic changes to reduce rejections of submitted electronic and paper claims.
• Ensure daily activities work towards company goals for cash collections and Accounts Receivable under 90 days, Ready to Bill (pending revenue) under 14 days, weekly and month end close processes and other departmental goals as outlined.
• Efficiently uses company billing software platform, including maintaining accurate and detailed patient and billing notes to assist in documentation and collection of claims.
• Tracking Unapplied Cash to ensure timely and accurate relief of aged accounts. Coordinate with cash team to ensure pending payment postings are accounted for properly and resolved timely.
• Must be able to communicate succinctly and professionally both verbally and through written correspondence with Physician offices, nurses, insurance companies and patients as needed.
• Exhibits a positive, courteous, respectful and helpful attitude towards patients, team members, payers, and management.
• Work within specified deadlines and open to overtime when necessary to meet department goals and objectives.
• Performs other tasks as assigned by Manager, Director and/or Senior Leadership.
• Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.

Requirements

• High School Diploma or GED.
• 3+ years experience Medical, HCPCS billing and collections
• 2-3 years Healthcare Accounts Receivable
• Medicare HCPCS knowledge
• Deadline Oriented, Time Management, Prioritization Skills

Nice-to-haves

• Specialty Pharmacy Infusion Billing
• 3+ years
• Specialty Pharmacy knowledge

Benefits

• Medical, Dental & Vision insurance
• 401k with a match
• Paid Time Off and Paid Holidays
• Tuition Reimbursement
• Paid Volunteer Day
• Floating Holiday
• Referral Incentive
• Paid Life, and short & long-term disability insurance

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