The Medical Insurance Accounts Receivable Representative is responsible for ensuring the timely collection of outstanding government or commercial healthcare insurance receivables.
Verifies or obtains patient eligibility and/or authorization for healthcare services performed by searching payer web sites or client eligibility systems, or by conducting phone conversations with the insurance carrier or healthcare providers.
Updates patient demographics and/or insurance information in appropriate systems.
Conducts research and appropriately statuses unpaid or denied claims.
Monitors claims for missing information, authorization and control numbers (ICN//DCN).
Researches EOBs for payments or adjustments to resolve claims.
Contacts payers by phone or through written correspondence to secure payment of claims.
Accesses client systems for information regarding received payments, open claims and other data necessary to resolve claims.
Follows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems.
Secures medical documentation as required or requested by third party insurance carriers.
Obtains billing guidelines and requirements by researching provider billing manuals.
Writes appeal letters for technical appeals.
Verifies accuracy of underpayments by researching contracts and claims data.
In the event of an authorization, coding, level of care and/or length of stay denial, prepares claims for clinical audit processing.
Supports nThrive's Compliance Program by adhering to policies and procedures pertaining to HIPAA, FDCPA, FCRA, and other laws applicable to nThrive's business practices. This includes: becoming familiar with nThrive's Code of Ethics, attending training as required, notifying management or nThrive's Helpline when there is a compliance concern or incident, HIPAA-compliant handling of patient information, and demonstrable awareness of confidentiality obligations.
High school diploma or GED.
At least two years of experience in healthcare insurance accounts receivable follow up, working with or for ahospital/hospital system, working directlywith government or commercial insurance payers.
Experience identifying billing errors and resubmitting claims as well as following up on payment errors, low reimbursement and denials.
Experience reviewing EOB and UB-04 forms to conduct A/R activities.
Knowledge of accounts receivable practices, medical business office procedures, coordination of benefit rules and denial overturns and third-party payer billing and reimbursement procedures and practices.
At least two years of experience with accounts receivable software.
Experience navigating payer sites for appeals/reconsiderations, benefits verification and online claims follow up.
Demonstrated ability to navigate Internet Explorer and Microsoft Office, including the ability to input and sort data in Microsoft Excel and use company email and calendar tools.
Demonstrated success working both individually and in a team environment.
Demonstrated experience communicating effectively with payers, understanding complex information and accurately documenting the encounter.
Ability to work effectively with cross-functional teams to achieve goals.
Demonstrated ability to meet performance objectives.
Experience with Epic, Meditech, Cerner, Invision, Paragon, Soarian, Collections Management or STAR.
Experience working with or for ahospital/hospital systemwith more than 250 beds.
Experience with both hospital (facility) and physician (pro-fee) A/R.
Be Inspired. Ignite Change. Transform Health Care.
From Patient-to-PaymentSM, nThrive provides all the technology, advisory expertise, services, analytics and education programs health care organizations need to thrive in the communities they serve. Our colleagues share a united passion to help health care organizations strengthen their financial position, which translates to accessible, quality care for all. This passion fuels our drive to innovate and participate in community outreach through the nThrive CARES program. Our colleagues are encouraged to think differently and empowered to make a lasting impact that ensures our health care providers, and our world, are healthy and productive.