Insurance AR Specialist

Role Summary

This role reviews monthly accounts receivables, follow up for resolution, insurance contact and claim re-files when necessary. Responsible for all aspects of insurance management of assigned payers including follow-up, research, and problem resolutions.

The individual will need to have expertise in medical billing and collections, as well as a strong understanding of insurance reimbursement processes and regulations related to proton therapy, radiation therapy, and radiology services. The successful candidate will work closely with patients, physicians, and insurance companies to ensure that accurate and timely payments are received, and outstanding balances are collected.

Responsibilities

• Works and/or maintains every account in the assigned AR in the 60+ day categories. Reviews EOBs within a two-week turnaround.
• Documents accurate collection activity in the collection tracking notes.
• Evaluates status of accounts and prioritizes collection action (letters, phone calls, staff assistance).
• Calls on outstanding balances due from carriers in a timely manner.
• Telephone, interview, and counsel patients on outstanding self-pay balances.
• Responds to incoming telephone or mail inquiries in a prompt, timely manner.
• Completes write-off adjustment forms for accounts needing necessary adjustments and turns in to supervisor with appropriate documentation attached.
• Maintains collection logs for distribution to other teams for use in identifying areas needing attention/correction.
• Advises supervisor of any unusual collection accounts as they become delinquent or are in question.
• Prepares daily user reports for supervisor review and filing along with appropriate notes/documentation.
• Works with other departments to gather necessary information for proper account work/collection activity.
• Maintains a complete understanding of HCPCS/ICD/CPT oncology coding and specific carrier requirements/knowledge.
• Additional responsibilities may be assigned to help drive our mission of improving the lives of everyone living with cancer.

Required Qualifications

• High school diploma or equivalent required
• Bachelor's degree preferred
• Minimum of 3 years of experience in medical collections required, preferably in an Oncology healthcare setting
• Radiation Oncology/Proton experience a plus
• Expertise in insurance policies and regulations related to medical billing, including Medicare and Medicaid

Essential Competencies

• Attendance is an essential job function.
• Detailed knowledge of billing, HCPCS, CPT and ICD codes
• Previous commercial collections experience preferred
• Ability to work effectively with all levels of management and other colleagues, demonstrating initiative, mature judgment and customer service orientation.
• Effective verbal and written communications, including active listening skills and skill in presenting findings and recommendations.
• Exceptional Multi-tasking, organizational skills and superb attention to detail.
• Strong analytical skills
• Skill in negotiating issues and resolving problems.
• Excellent customer service skills.
• Proficient in the use of end-user computer applications regarding productivity (MS Word, Excel, Outlook), database and patient billing and other medical information systems.
• Ability to operate various types of office equipment.
• Must possess high degree of professionalism and adaptability.

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