The Accounts Receivable Follow Up Specialist performs all collection and follow up activities with third party payers to resolve all outstanding balances and secure accurate and timely adjudication. This position is responsible for net and gross outstanding in accounts receivable, percentage of accounts aged greater than 90 days, cash collections, and denials resolution in support of the team efforts in the achievement of accounts receivable performance goals.
The Specialist performs daily activities related to the successful closure of aged accounts receivable. Responsibilities Performs online account status checks and contacting payers to follow-up on outstanding claim balances of assigned accounts in work queues. Clearly documents in EMR system the patient account notes, the payment status of the account, and/or actions taken to secure payment.
If applicable, requests account for additional follow up activity within a prescribed number of days in accordance with payer specific filing requirements or processing time required for insurance to complete processing. Performs required actions to resolve the account balance promptly by submitting appeals, correcting account information, coordinating requests for medical records, requesting and/or performing posting of account adjustments, requesting an account rebill and any and all other actions necessary to secure account payment and/or bring the account to successful closure.
Documents, tracks, and ensures a reasonable turnaround time of receipt of any outstanding documents required from external departments. Responds to claim denials from payers such as inability to identify the patient, coordination of benefits, non-covered services, past timely filing deadlines, and ensures all information is provided to the payer. Documents all actions taken on accounts in the EMR system account notes to ensure all prior actions are noted and understandable.
Informs the supervisor of any problems or changes in payer requirements and exercises independent judgment to analyze and report repetitive denials to take appropriate corrective action. Achieves established productivity and quality standard as determined by the Baptist Productivity and Quality Expectations Documentation Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact patient account collections.
Adheres to internal controls for applicable state/federal laws, and the program requirements of accreditation agencies and federal, state and private health plans. Seeks advice and guidance as necessary to ensure proper understanding. Effectively utilizes payer websites as needed in the execution of daily tasks.
Conducts account claim status and follow up and resolves claim payment denials. Monitors assigned work queues at all sources and ensures expeditious resolution while working with other departmental representatives in resolution. Reports unresolved issues and concerns impeding the collection process and to ensure successful account resolution.
Complies with patient confidentiality policies for the retention of patient health information, or when handling, distributing, or disposing of patient health information. Performs other duties as assigned by the Supervisor. Specifications Experience Minimum Required Experience in the healthcare setting or educational coursework Preferred/Desired One (1) year experience in physician’s office or hospital setting.
Education Minimum Required Preferred/Desired Training Minimum Required PC skills and keyboarding Working knowledge of 10 key, typing and computers. Proficiency in Microsoft Office Preferred/Desired Knowledge of insurance billing and collections and insurance guidelines. Special Skills Minimum Required Ability to type and key accurately, problem solving, written an d oral communication skills, financial counseling skills - knowledge of insurance billing (both hospital and professional settings) and collections - knowledge of insurance guidelines as it relates to CMS guidelines, TennCare and/or Medicaid based by state specified requirements.
Ability to recognize and communicate to clinical staff or designee when insurance companies require additional review because of NCCI, CCI , LMRP, Mutually Exclusive and Medical Necessity edits. Effective Verbal, written and customer service skills as it relates to patients and insurance companies. Able to create communications to patients and insurance companies as needed to resolve issues to complete billing/claim processes.
Preferred/Desired Knowledge of ICD-9, ICD-10, CPT and HCPCS codes and certification and/or degree in Healthcare Administration Business, Finance or related fields preferred. Licensure n/a Minimum Required Preferred/Desired