Revenue Cycle Accounts Receivables Specialist

U.S. Dermatology Partners; Tyler (TX); On-site; USD 42,000 - 56,000; Full time

Job summary

U.S. Dermatology Partners is seeking a detail-oriented accounts receivable specialist to manage medical billing for payors and patients, maximizing collections. You will liaise with practices, clinics, the business office, payors, and patients, and ensure accurate receivable status while maintaining confidentiality.

Responsibilities include verifying coverage, preparing claim forms, handling denials, and ensuring compliant processes in line with established policies and procedures.

Responsibilities

• Follows up on unpaid insurance claims after denial to obtain settlement.
• Enter data to maintain billing records and insurance form data.
• Verify patient coverage and benefits information with insurance companies.
• Prepare and mail insurance claim forms and patient statements.
• Check insurance claim forms for accuracy and refiling corrections.
• Review EOBs including Medicare/Medicaid payments for accuracy.
• Adjust claims from out-of-network to in-network rates and process write-offs.
• Repost payments to appropriate accounts and respond to patient inquiries.
• Answer questions about statements, coverage, and keep messages accurate.

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. Maintains accurate information regarding patient accounts receivables status. Maintains strict confidentiality for all patient 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 request
• Establishes 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 organization