Accounts Receivable Specialist (REMOTE)

CommUnityCare Health Centers; Austin (TX); On-site; USD 65,000 - 88,000; Full time

Job summary

CommUnityCare Health Centers in Austin, TX is seeking an Accounts Receivable Specialist to support the Revenue Cycle Management team in follow up and resolution of insurance claims. You will investigate denials, collect past due amounts, and document claim status with detailed notes.

The ideal candidate has 3+ years in AR with payers, strong Excel skills, and a solid understanding of ICD-10, CPT, HCPCS, HIPAA.

Qualifications

• 3 years of experience in Accounts Receivable with payers
• 1 year experience communicating with insurance payers and internal teams
• 3 years working with medical terminology, ICD10, CPT, HCPCS, and HIPAA requirements
• 2 years data processing and analytical skills, proficiency in Excel and Microsoft Office Suite
• 3 years working with commercial, government and state insurance payers and their reimbursement policies
• 3 years experience handling complex insurance issues, including refunds and payer assignments

Responsibilities

• Follow up with insurance carriers on past due amounts and resolve denials or benefit changes
• Maintain an accurate aging of accounts and perform AR analysis
• Stay informed on billing policies for all payers and reimbursement processes
• Create and follow up on appeals for denials or incorrect payments
• Review complex denials and coordinate with posting team to resolve issues
• Collaborate with RCM departments to resolve payment issues
• Uphold compliance with policies and the organization’s mission and values
• Review open accounts with AR Supervisor and report status
• Perform other duties as assigned

Skills

Customer service

Data entry

Attention to detail

Problem solving

Multi-tasking

Communication

Relationship building

Time management

Ethical behavior

Education

High School Diploma or GED

Tools

Excel

EMR software

Job description

Reporting to the Accounts Receivable Supervisor, this role supports the operations of the CommunityCare Revenue Cycle Management (RCM) team related to the follow up and resolution of outstanding insurance claims. Goal of the position is to follow up on, investigate and resolve claims that have been submitted to insurance for payment and to create detailed notes that provide insight into the current status of the individual claims.

Essential Functions

• Contact insurance carriers on a daily basis to follow up on/collect past due amounts on outstanding medical claims regarding denials or benefit changes.
• Maintain an accurate, up to date aging of assigned accounts including AR analysis and follow up.
• Keep educated on billing and medical policies for all payers.
• Have a working knowledge of In and Out of Network reimbursement processes/methodologies.
• Create and follow up on appeals needed to protest denials or incorrect payments.
• Review complex denials/tasks assigned by the payment posting team and resolve accordingly including reviewing refund requests, disputes and appeal as necessary.
• Work across all RCM departments to get issues related to claims payment resolved.
• Uphold and ensure compliance and attention to all company policies and procedures as well as the overall mission and values of the organization.
• Work with AR Supervisor to review/resolve open accounts as assigned.
• Perform other duties as assigned.

Knowledge, Skills and Abilities

• High level of skill at building relationships and providing excellent customer service.
• Ability to utilize computers for data entry, research and information retrieval.
• Strong attention to detail and accuracy and multitasking.
• Must have highly developed problem-solving skills.
• Executes excellent customer service and professionalism when interacting with staff, payers, patients and families to ensure all are treated with kindness and respect.
• Through leadership and by example, ensures that services are provided in accordance with state and federal regulations, organizational policy, and accreditation/compliance requirements.
• Acts in accordance with CommUnityCare’s mission and values, while serving as a role model for ethical behavior.
• Promptly identify issues and reports them to their direct supervisor.
• Maintain regular and predictable attendance.
• Acts in accordance with CommunityCare's mission and values, while serving as a role model for ethical behavior
• Manage high volumes of work and organize/maintain a schedule independently.
• Must be able to effectively monitor steps in claims processing operations.

Minimum Education

• High School Diploma or GED

Minimum Experience

• 3 years of experience managing Accounts Receivable and performing direct follow up with payers.
• 1 year experience communicating effectively, both orally and in writing, with insurance payers and internal company communications.
• 3 years working with medical terminology, ICD10, CPT, HCPCs coding and HIPAA requirements.
• 2 years of experience with data processing and analytical skills, proficiency in Excel and Microsoft Office Suite as well as medical practice management software and electronic medical records.
• 3 years of experience working with commercial, government and state insurance payers and their reimbursement policies and procedures.
• 3 years' experience working complex insurance issues, including assigning correct payer, EOB adjustments and refunds to accounts.