Job Summary:
The Accounts Receivable Follow-Up and Claim Edits Specialist II is responsible for follow-up duties to collect on all open A/R with insurance companies and third parties, as well as the daily review of claim edits from the Epic system.
The Account Receivable Follow-Up and Claim Edits Specialist II is part of a team that works to review, evaluate and improve the clinical denial and appeal process within the division and ensures the highest level of revenue capture and resolution. Specialties include Cardiology, Interventional Cardiology, Internal Medicine, Gastroenterology and Endocrinology.
Job Responsibilities:
- Contact insurance carriers regarding open, pending and rejected or partially adjudicated claims and invoices, as well as preparing accounts for appeals processes.
- Follow up on open receivables, working across payers from the highest dollar value to the lowest.
- Identify coding issues and communicate back to supervisor.
- Research root issue of denial and pursue proper course of appeal, as well as to follow up and obtain payment.
- Address incoming correspondence and prepare correspondence to insurance companies, patient and/or guarantor.
- Contact insurance companies/patient/guarantor to obtain status of outstanding claims and submitted appeals.
- Document the claim issue and course of action taken on every account worked.
- Escalate issues and problems to Supervisor as appropriate.
- Perform charge corrections.
- Perform demographic and insurance coverage updates on account, run eligibility and bill new insurance.
- Assists with cases of higher complexity. Engages Team Lead or Supervisor as appropriate.
- Assists with on boarding and training new staff in revenue cycle processes.
- May assist with special projects as directed by Supervisor/Manager.
- Perform other related duties as assigned.
Job Qualifications:
- High school graduate or equivalent is required.
- A minimum of 2 years’ experience in a physician billing or third party payor environment.
- Candidate must demonstrate a strong customer service and patient focused orientation and the ability to understand and communicate insurance benefits explanations, exclusions, denials, and payer claim and appeal forms.
- Candidate must demonstrate strong proficiency in medical terminology, diagnosis and procedure coding.
- Must demonstrate effective communication skills both verbally and written.
- Strong organizational and problem solving skills, and the ability to set priorities among multiple competing objectives, tasks and initiatives is required. Ability to multi-task, prioritize, and manage time effectively.
- Strong proficiency in computer software skills (e.g. Microsoft Word, Excel and Outlook, E-mail, etc.)
- Associate degree or higher is preferred.
- Prior experience in EPIC is preferred.
- Prior experience and/or strong proficiency of Electronic Health Record systems is preferred.
- Prior experience in a medical office setting is preferred.
- Bilingual English/Spanish is a plus.
Hourly Rate Ranges: $22.78 - $30.77
Note: Our salary offers will fall within these ranges based on a variety of factors, including but not limited to experience, skill set, training and education.
61st Street Service Corporation
At 61st Street Service Corporation we are committed to providing our client with excellent customer service while maintaining a productive environment for all employees. The Service Corporation offers a competitive comprehensive Benefit package to eligible employees; including Healthcare and various other benefits including Paid Time off to promote a healthy lifestyle.
We are an equal employment opportunity employer and we adhere to all requirements of all applicable federal, state, and local civil rights laws.
