Medical Insurance Accounts Receivable Representative II

Nthrive Inc Raleigh , NC 27611

Posted 2 months ago


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.

Preferred Skills

  • 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.

About nThrive

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.

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Insurance Company Examiner II

State Of North Carolina

Posted 4 days ago

VIEW JOBS 12/12/2019 12:00:00 AM 2020-03-11T00:00 Description of Work This is a repost, previous applicants do not need to reapply RECRUITMENT SALARY - $56,046 - $70,500 Salary Grade: GN15 Mission of the Department of Insurance: To promote a stable insurance market through unbiased regulation and to protect the lives and property of every citizen in all 100 counties while fostering superior, user-friendly service, courtesy and respect. Description of Work: This senior financial analyst position, which is part of the Captive Insurance Companies Division, will conduct initial and supervisory financial analysis of North Carolina domestic risk retention groups ("RRG") and RRG license applicants, utilizing the latest automated financial analysis systems and procedures intended to safeguard the financial solvency of these companies. The position will evaluate applications to determine if RRG or captive manager applicants meet the requirements for approval or licensing, and upon completion of each evaluation, this position will recommend appropriate North Carolina Department of Insurance ("Department") action. The position will also conduct initial and supervisory financial analysis of licensed RRGs to determine if they are compliant with applicable laws, regulations, procedures, and accounting practices required by this State. This position will render an opinion on the financial health of each assigned RRG, recommend any appropriate corrective actions, evaluate RRG proposals such as material business plans changes, dividend payments, and loans to or investment in affiliates, which require the approval of the Commissioner. During peak work periods, the position will also assist in the Division's responsibilities relative to financial analysis of non-RRG applicants and captive insurers. The position will interact with people at all levels of experience within the captive insurer industry as well as within this Department. This interaction will include attendance at captive insurer conferences and events where public speaking may be required. The work is guided by state laws and regulations, Departmental policies and procedures, and guidance provided by the National Association of Insurance Commissioners. Some work over 40 hours and minimum travel will be required. Positions in this class perform initial and supervisory professional analysis/examination work responsible for monitoring and regulating the operations and financial condition of all proposed and authorized regulated entities, for compliance with the solvency laws of North Carolina. Work involves independently analyzing and/or examining financial statements, mergers, acquisitions, independent auditor reports, actuarial reports, business plans, operations and systems. Employees interact with Department management and lower and mid-level staff of regulated entities. The position documents findings and makes recommendations on necessary and appropriate actions based on pre-established guidelines and State law. Knowledge, Skills and Abilities / Competencies Qualified applicants must submit an application that clearly reflects experience that demonstrates the following: * Previous work experience conducting and/or supervising financial audits or analysis or performing closely related accounting responsibilities. * Advanced experience utilizing accepted accounting principles, statutory accounting principles, financial analysis procedures, and generally accepted auditing standards. * Advanced experience with financial statements, financial ratios and journal entries on financial statement components. SPECIAL REQUIREMENT: The appropriate courses in accounting as defined in 21 NCAC 8A.0309 and other courses required to qualify as a candidate for the uniform certified public accountant examination is required. Therefore, applicants are asked to attach a copy of their current transcript. Minimum Education and Experience Requirements Bachelor's degree from an appropriately accredited college or university, with the appropriate courses in accounting as defined in 21 NCAC 8A.0309 and other courses required to qualify as a candidate for the uniform certified public accountant examination, based on the examination requirements in effect at the time of graduation And three years of experience in auditing insurance company operations or closely related accounting or auditing work; OR, an equivalent combination of education and experience. MANAGEMENT PREFERENCE: Management prefers applicants who possess the following: * CPA OR CFE designation (or demonstration that applicant is actively working towards one of those designations) * Exceptional verbal and written communication skills * Ability to speak publicly with at various captive insurance industry events * Working knowledge of Microsoft Office Software Supplemental and Contact Information For consideration for this vacancy, all applicants must complete an on-line application using this link, If multiple applications are submitted to an individual posting, only the most recent application received prior to the posting close date will be evaluated for the consideration. Applications for positions requiring specific coursework must be accompanied by a copy of the applicant's transcript. Academic Degrees must be from appropriately accredited institutions and will be verified. If you are selected for a position at DOI/IC, your academic credentials will be verified. To receive credit for your work history and credentials, you must list the information on the State Application. Any information omitted from your application cannot be considered for qualifying credit. The Department of Insurance/Industrial Commission will conduct criminal history checks of all job applicants recommended for employment. Failure to accurately acknowledge information on criminal convictions on the state application form will be grounds for non-consideration of applications, disciplinary action, and possible criminal prosecution. The Department of Insurance/Industrial Commission uses the merit-based recruitment and selection plan to fill positions subject to the State Personnel Act with the most qualified individuals. * INCLUDE ALL RELEVANT EDUCATION, WORK EXPERIENCE IN THE DESIGNATED EDUCATION AND WORK HISTORY SECTION ON THE FORMAL APPLICATION* * Applications with "see attached" or resumes in lieu of completed education and work experience on the formal application will be deemed incomplete and will not be eligible for consideration for the vacancy* Applicants requesting and receiving an accommodation under the Americans with Disabilities Act (ADA) are eligible to submit paper applications via mail or by fax. Applicants seeking Veteran's Preference under N.C.G.S .126 must submit a DD Form 214, Certificate of Release or Discharge from Active Duty. This information may be attached to the online application or be faxed on or before the closing date. Applicants may check the status of their application for a vacancy at any time by logging in to the government jobs system using the above link. Once the applicant has logged in, the status of each submitted application is documented next to each vacancy for which he/she has applied. Tanesha Leach, Agency HR Consultant NC Department of Insurance Human Resources Office Phone: (919) 807-6049 State Of North Carolina Raleigh NC

Medical Insurance Accounts Receivable Representative II

Nthrive Inc