Accounts Receivable Specialist - Hospitals

Avem Health Partners; Oklahoma City (OK); On-site; USD 42,000 - 60,000; Full time

Job summary

Avem Health Partners in Oklahoma City seeks an Accounts Receivable Specialist to manage patient accounts and maximize reimbursement. You will perform insurer follow-up, resolve denials, and ensure timely processing of claims in coordination with facilities.

The role requires at least two years of medical AR experience, knowledge of UB-04 and CMS-1500 forms, and a medical billing certification if available. You will comply with regulations and contribute to revenue cycle improvements.

Qualifications

• High school diploma or equivalent
• At least two years of medical accounts receivable experience
• Certification in medical billing, if available
• Knowledge of UB-04 (CMS-1450) and CMS-1500 claim forms
• Ability to obtain documentation to resolve claims
• Compliance with state and federal regulations

Responsibilities

• Manage assigned patient accounts to maximize reimbursement and timely payments
• Request claim reprocessing and submit corrected claims as needed
• Perform follow-up on insurance claims beginning 30 days from service
• Review and resolve credit balance accounts and misapplied payments
• Address returned claims, denials, and rebills within two working days
• Identify denial trends and communicate to Revenue Cycle Manager
• Maintain knowledge of payer guidelines and billing requirements
• Assist in revenue cycle process improvements
• Maintain confidentiality of patient and financial information

Skills

Accounts Receivable

Medical billing

Customer service

Attention to detail

Communication

Education

High school diploma

Job description

JOB PURPOSE:The Accounts Receivable Specialist is primarily responsible for effective collection of patient accounts, accounts receivable follow-up, and reimbursement analysis for all non-government accounts to ensure timely and maximum reimbursement for client HOSPITALS.ESSENTIAL FUNCTIONS INCLUDE BUT NOT LIMITED TO:Manage assigned accounts to ensure outstanding and pending claims are resolved and paid at maximum reimbursement in a timely manner.Request claim reprocessing when appropriate and prepare and submit corrected claims as needed.Conduct follow-up on all outstanding insurance claims beginning at 30 days from date of service.Review and resolve credit balance accounts, including payer and patient refund requests and misapplied payments or adjustments.Address returned claims, correspondence, denials, account reconciliations, and rebills within two working days of receipt.Identify and communicate denial trends to the Revenue Cycle Manager.Maintain working knowledge of insurance guidelines, including HMO, PPO, Medicare, and Medicaid.Demonstrate knowledge of institutional and professional billing requirements, including UB-04 (CMS-1450) and CMS-1500 claim forms.Obtain necessary documentation or clarification from facilities to resolve claims.Ensure compliance with state and federal regulations, payer guidelines, and company policies and procedures.Assist in developing, implementing, and improving revenue cycle processes.Maintain strict confidentiality of patient and financial information.Support management with special projects and perform other duties as assigned.BEHAVIORAL STANDARDS:The individual must support the mission, vision, and goals of Avem Health Partners and serve as a role model within the company.Exhibit positive customer service behavior in everyday work interactions.Demonstrate a courteous and respectful attitude to internal workforce and external customers.Communicate accurately and appropriately.Handle difficult situations in a discreet and professional manner.Hold self-accountable for professional practice.Demonstrate knowledge of unit goals and is active in committees and projects to achieve these goals.Keep current with literature regarding changing practices, interventions, and best practices in patient care.Assume responsibility for seeking out educational and professional opportunities for personal learning needs and growth as well as meeting mandatory education requirements.Act as a preceptor as requested.Demonstrate excellent work attendance and attend and actively participate in a variety of meetings and training sessions as required.Adhere to the Avem Health Partners Code of Conduct and Standards of Behavior. Complies with established policies and procedures and all health and safety requirements.EDUCATION:High school diploma or equivalentAt least two years of medical accounts receivable experienceCERTIFICATION/LICENSURE:Medical billing certification, if available.PHYSICAL REQUIREMENTS:To perform this job successfully, an individual must be able to perform each essential job duties satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant to be considered.This job requires visual abilities, auditory abilities, must be intact to perform duties.