Medical Billing Accounts Receivable Specialist

JOB PURPOSE: Primarily responsible for effective collection on patient accounts, accounts receivable follow-up, and reimbursement analysis for all non-Government accounts. ESSENTIAL FUNCTIONS INCLUDE BUT NOT LIMITED TO: Manage assigned accounts ensuring outstanding/pending claims are paid at maximum reimbursement in a timely manner. Request claims to be reprocessed where necessary or prepare and submit corrected claims to the insurance companies for payment. Follow-up on all outstanding insurance claims at 30-days from the date of service with an emphasis on maximizing patient satisfaction and client profitability. Review credit balance accounts for payer/patient refund requests and/or misapplied payments/adjustments. Follow up on all returned claims, correspondence, denials, account reconciliations and rebills within two working days of receipt to achieve maximum reimbursement in a timely manner. Communicate denials trends with Revenue Cycle Manager. Knowledge of insurance guidelines, including HMO/PPO, Medicare, and Medicaid. Obtain accurate and additional information from facilities as needed. Comply with state and federal regulations, laws and company policies and procedures. Help create, implement, and improve processes for the revenue cycle team. Maintain strictest confidentiality. Support management on special projects Other duties as assigned. BEHAVIORAL STANDARDS: The individual must support the mission, vision, and goals of Avem Health Partners and serve as a role model within the company. Exhibit positive customer service behavior in everyday work interactions. Demonstrate a courteous and respectful attitude to internal workforce and external customers. Communicate accurately and appropriately. Handle difficult situations in a discreet and professional manner. Hold self-accountable for professional practice. Demonstrate knowledge of unit goals and is active in committees and projects to achieve these goals. Keep current with literature regarding changing practices, interventions, and best practices in patient care. Assume responsibility for seeking out educational and professional opportunities for personal learning needs and growth as well as meeting mandatory education requirements. Act as a preceptor as requested. Demonstrate excellent work attendance and attend and actively participate in a variety of meetings and training sessions as required. Adhere to the Avem Health Partners Code of Conduct and Standards of Behavior. Complies with established policies and procedures and all health and safety requirements. EDUCATION: High school diploma or equivalent At least two years of medical accounts receivable experience CERTIFICATION/LICENSURE: Medical billing certification, if available. PHYSICAL REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential job duties satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant to be considered. This job requires visual abilities, auditory abilities, must be intact to perform duties.