The AR Follow-up/Denials is responsible for working accounts to ensure they are resolved in a timely manner. This candidate should have a solid understanding of the Revenue Cycle as it relates to the entire life of a patient account from creation to payment. Representative will need to effectively follow-up on claim submission, remittance review for insurance collections, create and pursue disputed balances from both government and non-government entities. Basic knowledge of Commercial, Managed Care, Medicare and Medicaid insurance is preferable. An effective revenue cycle process is achieved with working as part of a dynamic team and the ability to adapt and grow in an environment where work assignments may change frequently while resolving accounts with minimal assistance.

Responsibilities and Duties

Perform duties as assigned in a professional demeanor, which includes interacting with insurance plans, patients, physicians, attorneys and team members as needed.
Basic computer skills to navigate through the various system applications provided for additional resources in determining account actions.
Access payer websites and discern pertinent data to resolve accounts.
Utilize all available job aids provided for appropriateness in Patient Accounting processes.
Maintain department daily productivity goals in completing a set number of accounts while also meeting quality standards as determined by leadership.
Identify and communicate any issues including system access, payor behavior, account work-flow inconsistencies or any other insurance collection opportunities.
Provide support for team members that may be absent or backlogged.
Processes accounts and works with designated payors to resolve outstanding balances.
Perform corrective actions required to resolve the account using the appropriate resources and applications.
Responsible for managing and collecting outstanding accounts receivable balances for the company.
Work with payer to resolve outstanding balances.
Communicate with internal departments to resolve billing discrepancies.
Maintain accurate and up-to-date records of all collections activity.
Will work on Appeal Follow Up:
- Low Dollar Buckets - G10- 80-90%
- High Dollar Bucket - 10-20%
Produces claims at 100% and up

Functional Area Outcomes and Expectations

To successfully perform medical billing job through taking and completing each essential duty satisfactorily.
Proficiency in utilizing ACE and the editors.
Ensuring compliance with HIPAA and other medical insurance guidelines

Knowledge, Skills, and Abilities

Able to learn to be an effective user of the practice management system.
Adhere to company processes, procedures, and policies.
Ensuring compliance with HIPAA and other medical insurance guidelines.

Required and Preferred Qualifications

3 years medical claims and/or AR Management experience, payment posting/reconciliation is a plus
Minimum typing requirement of 45 wpm

AR Follow Up/Denials

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