Process patient claims, follow up on claim statuses, correct rejections, submit rebills and appeals, and research eligibility, documentation, authorizations, and billing guidelines. Maintain payer and client relationships while ensuring compliance with HIPAA, OSHA, fraud and abuse laws, and other regulatory requirements.
US Heart and Vascular is in need of a Remote Accounts Receivable Specialist to join our team.
Responsibilities:
- Responsible for billing all patient claims in a timely manner
- Perform basic claims follow up activities to include claim status checks, basic claim edits corrections and rebills.
- Work daily claims rejection lists including but not limited to, eligibility, coordination of benefits, clearinghouse smart edits, etc.
- Utilize clinical applications, payer websites and other systems as a research tool to retrieve medical documentation, patient eligibility information, billing guidelines, patient referrals, and hospital or procedure code authorizations to substantiate corrected claims submissions.
- Establish and maintain effective working relationships with carrier representatives and internal and external clients. Remain abreast of carrier/payer updates as it relates to Billing and Collections guidelines including claim submissions, claim appeals, grievance procedures and policy changes
- Utilize clinical applications, payer websites and other systems as a research tool to retrieve medical documentation, patient eligibility information, billing guidelines, patient referrals, and hospital or procedure code authorizations to substantiate corrected claims submissions, through written appeals, and coding reviews, etc.
- Responsible for compliance with all regulatory requirements and/or guidelines. These requirements/guidelines include, but are not limited to: OSHA, HIPAA, Federal Fraud and Abuse laws.
Requirements:
- High School Diploma or equivalent required
- Knowledge of the accounts receivables (A/R) process
- Bachelor's Degree in a related field preferred but not required
- Minimum of 3 years of healthcare or insurance billing processing experience required
- Knowledge of medical terminology, CPT, ICD-10-CM, HCPC codes, CCI edits and HIPAA regulations
- eClinicalWorks experience preferred but not required
- Proficient in medical terminology, anatomy, and physiology
- Strong knowledge of ICD-1O coding
- Familiarity with medical office procedures and billing practices
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