Insurance A/R Specialist III

Austin Health Partners; Austin (TX); Hybrid; USD 52,000 - 65,000; Full time

Job summary

Austin Health Partners is seeking an Insurance AR Specialist III in Austin, TX. The role focuses on managing outstanding insurance accounts, timely filing of claims, and posting rejections with explanations. It requires strong attention to detail and excellent customer service.

The position is full-time in the Central Business Office, with a hybrid work option after in-office training and potential return to office if needed, reporting to the Director of Billing Services.

Qualifications

• Minimum of 3 years experience in revenue cycle management.
• Familiarity with Medicaid, Medicare and Commercial Insurance.
• Familiarity with CPT and ICD 10 coding; knowledge of medical terminology.

Responsibilities

• Thoroughly research reasons for denied claims and work appeals to resolve balances.
• Resolve denials/appeals within 72 hours of receipt.
• Review previously worked claims within a minimum of 30 days.
• Resolve professional billing claim and clearinghouse edits as well as payer rejections.
• Resolve claims greater than 60 days from date of service.
• Work a minimum of 50 claims a day.
• Communicate with Coders to handle coding-related claim edits and appeals.
• Identify and document new payer denial trends and notify supervisor for escalated follow up.
• Manage patient and payer credit balances per policy.

Skills

Revenue cycle management

CPT ICD-10 coding

Medical terminology

Education

High School Diploma

Some college preferred

Tools

Practice management software

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Insurance A/R Specialist III

Full-Time BILLING Central Business Office, Austin, TX, US

JOB DESCRIPTION

Insurance AR Specialists will be responsible for the management of outstanding insurance accounts through written or verbal direction from insurance carriers for the accurate and timely filing of claims for maximum reimbursement and posting rejections with accurate explanations. Insurance A/R Specialist duties include answering patient balance inquiries and providing outstanding customer service.

CLASSIFICATION

Non-Exempt

REPORTS TO

Director of Billing Services

ESSENTIAL JOB FUNCTIONS & RESPONSIBILITIES

• Thoroughly research reasons for denied claims and work appeals as necessary to resolve outstanding balances
• Responsible for resolving denials/appeals in the Hold bucket within 72 hours of receipt
• Review previously worked claims within a minimum of 30 days
• Responsible for the accurate and timely resolution of professional billing claim and clearinghouse edits as well as payer rejections
• Responsible for resolving claims that are greater than 60 days from date of service
• Work a minimum of 50 claims a day
• Communicate effectively with the Coders to handle the accurate and timely resolution of coding- related claim edits and appeals
• Identify and document new payer denial trends, and notify supervisor for escalated follow up
• Manage patient and payer credit balances with established policy and procedures
• Answer phone calls regarding billing inquiries and resolve billing issues in a polite and confident manner
• Create collections works lists and submit for provider approval
• Assist with charge entry back log
• Regular & prompt attendance on agreed upon daily and weekly start and end time
• Ethical conduct, confidentiality, and collaboration with the healthcare team are expected and considered essential elements of this position
• Other duties as assigned
• Can maintain physical demands and work environment as listed below

EDUCATION & EXPERIENCE

Required

• High School Diploma or equivalent
• Minimum of 3 years experience in revenue cycle management
• Good understanding of Medicaid, Medicare and Commercial Insurance
• Practice management software experience
• Familiarity with CPT and ICD 10 coding, familiarity with medical terminology

Preferred

• Some college preferred

PHYSICAL DEMANDS & WORK ENVIRONMENT REQUIREMENTS

The employee is routinely required to sit frequently, use a keyboard, mouse, telephone, headset, and other standard office equipment. Frequently communicate via text, email, phone, chat and video. The employee is occasionally required to sit; climb or balance; and stoop, kneel, crouch or crawl. The employee must frequently lift and/or move up to 25 pounds and occasionally lift and/or move up to 50 pounds. Works near others, usually within a few feet. This job will require occasional exposure to patient elements.

EXPECTED HOURS OF WORK

The core hours of work are Monday – Friday with an 8-hour work shift between the hours of 7:00 a.m. and 5:00 p.m. Hybrid work opportunity available upon successful completion of in-office training. Subject to return to office if additional training is required.

OTHER DUTIES

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change as necessary.