Accounts Receivable Specialist

Gi Care For Kids - Atlanta, GA

Full-time

Atlanta, GA

Ambulatory Health Care Services

About the position

The Accounts Receivable Specialist plays a crucial role in managing the financial interactions between the organization and its patients, as well as insurance companies. This position requires a strong customer service orientation and attention to detail, as the specialist will be responsible for handling accounts receivables, ensuring timely follow-ups, and resolving any billing issues that may arise. The specialist must be adept at managing multiple tasks daily, including correcting claim issues, rebilling claims to third-party payers, and writing appeal letters when necessary. Communication is key, as the specialist will interact with various departments, including front desk staff, nursing, and providers, to ensure the appropriate collection of co-pays and self-pay balances prior to patient visits. In addition to these responsibilities, the Accounts Receivable Specialist will be tasked with contacting patients to discuss out-of-pocket expenses after obtaining authorization, documenting communications, and handling inquiries from clerical and clinical staff as well as insurance companies. Daily monitoring of assigned insurance accounts receivables, statuses on delinquent self-pay accounts, and all assigned work queues is essential. The specialist must meet deadlines for completing all assigned work queues before the end of the month and identify and resolve patient billing questions that arise in the office or through incoming calls. The role also involves daily collection and posting of payments from insurance companies and patients, reviewing accounts for non-collectible status, and notifying the manager of any such accounts. The specialist will verify patient eligibility through various third-party sources and must have a solid understanding of patient benefits from various insurance carriers. Documentation of payments collected, accounts receivable, and phone call resolutions in the software system is required, along with monitoring changes in policy and fee schedules for all assigned insurance carriers. The specialist will also assist in the enrollment and explanation of drug rebate programs and patient assistance programs, ensuring effective communication with both professional staff and patients. Overall, this position is vital for maintaining the financial health of the organization and ensuring a smooth billing process for patients and insurance providers.

Responsibilities

• Follow up on all accounts within the timely filing guidelines of the insurance company assigned to the biller.
• Correct claim issues and/or rebill claims to third party payers within the timely refiling guidelines.
• Write appeal letters as necessary.
• Communicate with all departments to ensure appropriate collection of co-pays and self-pay balances prior to patient visits.
• Contact patients after obtaining authorization to discuss collection of out-of-pocket expenses prior to patient visits.
• Document communications with the appointment desk and call guarantors regarding balances that need to be collected.
• Handle inquiries and answer questions for clerical staff, clinical staff, and insurance companies within a 24-hour turnaround time.
• Daily monitor assigned insurance accounts receivables and statuses on delinquent self-pay accounts.
• Meet deadlines for completing all assigned work queues prior to the end of the month.
• Identify and resolve patient billing questions in the office and from incoming calls.
• Daily collection and/or posting of payments from insurance companies and patients as assigned.
• Review accounts and make recommendations regarding non-collectible accounts when working delinquent and collection accounts.
• Notify manager of non-collectible self-pays and insurance balances.
• Verify patient eligibility through various third-party sources.
• Understand patient benefits from various insurance carriers and determine out-of-pocket and in/out of network status prior to visits.
• Document payments collected, accounts receivable, and phone call resolutions in the software system.
• Understand fee schedules and update manager of fee schedule changes and effective dates timely.
• Monitor changes in policy and fee schedules for all assigned insurance carriers and inform manager.
• Answer business office phone calls daily and on a rotating weekly schedule.
• Explain out-of-pocket expenses to guarantors.
• Assist in the enrollment and explain drug rebate programs such as Care Path and Entyvio Connect and Pfizer Assist.
• Assist patients in completion of paperwork and follow up on patient assistance programs when needed.
• Communicate effectively with professional staff and patients.
• Daily monitor personal business office phone line, business office phone calls, and emails.
• Ensure voicemails are returned within a 24-hour time period.
• Respond to all emails and staff messages from manager, staff, and patients in a 24-hour time period.
• Daily collection of business office mail and routing to appropriate billers.
• File manually posted payments.
• Be cross-trained to fill in for other job functions on an as-needed basis.
• Perform additional duties as assigned by management.

Requirements

• Associate's degree or equivalent experience.
• 3 to 5 years related experience in accounts receivable or medical billing.
• Medical Billing Certification preferred.
• Experience working with medical payers including Medicaid, CMO's, and Commercial insurance.
• Working knowledge of medical billing systems, particularly Epic.
• Working knowledge of CPT and ICD-10 coding systems.
• Ability to research and problem-solve A/R disputes.
• Customer service oriented with strong interpersonal skills.
• Excellent organizational skills and proficiency in Microsoft Office Suite.
• Excellent verbal and written communication skills.
• Knowledge of medical billing and collection practices required.
• Strong keyboard skills and ability to work in a fast-paced environment with firm deadlines.
• Ability to perform multiple tasks effectively and work both independently and as part of a team.
• Strong analytical skills required for timely, independent decision-making.

Nice-to-haves

• Experience with patient monitoring systems.
• Familiarity with drug rebate programs and patient assistance programs.