AR Specialist (38948)

Responsibilities/Duties/Functions/Tasks:

• Conducts appropriate account follow up activities on final billed claims by contacting government agencies, third party payers, and patients/ guarantors via phone, email, or online.

• Working knowledge of commercial, third party insurance including Medicare, Managed Care, HMO and PPO.

• Timely follow-up on all accounts assigned, work accounts as established procedures until account is resolved, sent to legal, or disputed.

• Validate denial reasons and ensures coding is accurate and reflects denial reasons.

• Generate an appeal based on the dispute reason and contract terms specific to the payor. This includes online reconsideration.

• Responsible for maintaining working inventory of tasks with no backlog.

• Research contract terms/ interpretation and compile necessary supporting documentation for appeals.

• Consistently follows established processes and procedures for all assigned accounts and projects to ensure prompt payments and account resolutions.

Additional Responsibilities/Duties/Functions/Tasks (if applicable):

• Working knowledge of CMS guidelines to include Medicare the DDE and FSS systems

Qualifications

Qualifications

Education: High school diploma or GED.

Experience: Minimum three-four years of experience in a doctor's office, hospital setting, or CBO. Prior dermatology office experience is not required, but preferred.

Other Requirements: None

Performance Requirements:

• Quality written and verbal communication skills

• Superior computer skills

• Familiar with medical dermatology terms

• Professional in mannerisms

• Able to demonstrate compassion and patience in dealing with others, patients and co-workers alike

• Able to prioritize tasks, understand provider's and management's instructions, and know when to seek information or advice. Immediate and appropriate escalation of trends and issues to management which impact cash, aging and processes

• Maintains or exceeds 95% of established productivity goals and quality standards

• Follows time-keeping and attendance policy daily

• Follows and maintains patient, account and client confidentiality at all times. Adheres to HIPAA and Compliance Policy Guidelines

• Completes projects as assigned with detailed documentation on trends and issues to management

Equipment Operated: Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.

Work Environment: Position is in a well-lighted medical office environment. Occasional evening and weekend work.

Physical Requirements: Must possess the manual dexterity to operate office machines including computer and calculator; stooping, bending to handle files and supplies; and mobility to complete errands or deliveries. Environment could include handling sharps and chemicals. Stress can be triggered by multiple staff demands and deadlines.