Revenue Cycle Accounts Receivables Specialist

Paycom - ATS; Tyler (TX); On-site; USD 52,000 - 70,000; Full time

Job summary

US Dermatology Partners is seeking an experienced medical billing professional to manage accounts receivable for insurance payors and patients. You will follow up on denials, verify coverage, process claims, and maintain accurate AR data while protecting patient confidentiality.

Strong knowledge of Medicare rules, HIPAA, and billing procedures is required. Three or more years in medical billing and accounting is required.

Qualifications

• Thorough knowledge of medical accounts receivable collection procedures.
• Thorough knowledge of Medicare rules and regulations.
• Thorough knowledge of medical billing procedures and medical insurance workflows.
• Detail oriented, professional attitude and reliable.
• Ability to meet KPIs and build clear processes.
• Strong organizational skills to support leadership of the function.

Responsibilities

• Follow up on unpaid insurance claims after denial to obtain settlements.
• Key data into computer systems and prepare insurance forms with patient data.
• Communicate with insurance companies to verify coverage and benefits.
• Prepare and mail insurance claim forms and patient statements monthly.
• Review EOBs and adjust claims and write-offs as needed.
• Respond to patient and payor inquiries promptly and accurately.
• Maintain contacts with payor representatives and ensure proper documentation.
• Process patient refunds and handle discharged patient transactions.
• Adhere to safety policies and protect confidentiality of patient information.

Skills

Accounts receivable

Medical billing

Healthcare

Customer service

HIPAA compliance

Tools

Excel

Word

Outlook

Job description

SECTION 1: Job Summary (Summary of the basic functions of the position)\\Responsible for accounts receivables management and general medical billing for insurance companies(payors) and patients focused primarily on maximizing collections. Serves as a liaison between practices,clinics, the business office, payors, and patients. Establishes and maintains contacts with payor accounts’representatives. Initiates telephone contact and answers all calls pertaining to accounts. Maintainsaccurate information regarding patient accounts receivables status. Maintains strict confidentiality for allpatient accounts. Follows approved processes, policies and procedures in executing job duties.SECTION 2: Duties and Responsibilities (Responsibilities necessary to accomplish job functions)Follows-up on unpaid insurance claims after denial, to obtain settlement of claim.Keys data into computer to maintain billing records and prepare insurance form with data such as names of insurance company and policy holder, policy number, and physician diagnosis.Contacts insurance company to verify patient coverage and obtain information concerning extent of benefits.Generates appropriate paper work, including insurance claim forms (original and re-filed) and collection letters, mails monthly statements to patients.Reviews all insurance claim forms for accuracy and makes appropriate corrections for refiling.Reviews all insurance payments (Explanation of Benefits – EOB’s), including Medicare and Medicaid payments for accuracy in account information and demographics.Determines adjustments of claims paid at the out-of-network rate to in-network rates, and processes write-offs on these adjustments.Reposts payments, including insurance and patient payments to appropriate accounts as necessary.Answers patients' questions regarding statements and insurance coverage, answers telephone in a prompt, courteous, and helpful manner, screening calls, directing calls, providing information, answering questions, and taking accurate messages.Responds to all inquiries received from patients and payors either by telephone or written requestEstablishes and maintains contacts with payor accounts’ representatives.Reviews accounts receivable activities and calls on outstanding balances or claims.Processes patient refunds as needed.Handles transactions necessary on discharged patients.Completes and files all necessary paperwork for services rendered, i.e., charge tickets, patient forms, medical records, etc.Adheres to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.Performs other duties that may be necessary or in the best interest of the organizationSECTION 3: Experience RequirementsThree (3)+ years of work experience in medical billing and accounting experience.SECTION 4: Knowledge, Skills and Abilities RequirementsThorough knowledge of medical accounts receivable collection procedures, including knowledge of insurance correspondence required.Thorough knowledge of Medicare rules and regulations.Thorough knowledge of medical billing procedures and medical insurance, including credit and collection procedures required.Detail oriented, professional attitude, reliableStrives to achieve US Dermatology Partners Standard Key Performance Indicators (KPIs)Management and organizational skills to support the leadership of this functionAbility to follow or provide verbal & written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretationsInterpersonal skills to support customer service, functional, and team mate support needsAble to communicate effectively in English, both verbally and in writingMathematical and/or analytical ability for basic to intermediate problem solvingBasic to intermediate computer operationProficiency with Microsoft Excel, Word, and OutlookSpecialty knowledge of systems relating to job functionKnowledge of state and federal regulations for this position; general understanding of HIPAA guidelinesSECTION 5: Supervisory Responsibilities:This position has no supervisory responsibilities.