Accounts Receivable Follow Up Specialist

About This Role

This role is responsible for performing collections and follow-up activities with third-party payers to resolve outstanding balances and ensure timely adjudication. The specialist will manage accounts receivable performance goals, focusing on net and gross outstanding, aging accounts, cash collections, and denial resolution.

Responsibilities

• Perform online account status checks and contact payers to follow-up on outstanding claim balances of assigned accounts in work queues
• Clearly document in EMR system patient account notes, payment status, and actions taken to secure payment
• Perform required actions to resolve account balances promptly by submitting appeals, correcting account information, and coordinating medical records requests
• Document, track, and ensure a reasonable turnaround time for outstanding documents from external departments
• Respond to claim denials from payers regarding issues such as inability to identify the patient, coordination of benefits, and past timely filing deadlines
• Document all actions taken on accounts in the EMR system account notes to ensure clarity and understanding
• Inform supervision of any problems or changes in payer requirements and analyze repetitive denials for corrective action
• Achieve established productivity and quality standards as determined by Baptist Productivity and Quality Expectations Documentation
• Maintain knowledge of applicable rules, regulations, policies, laws, and guidelines that impact patient account collections
• Effectively utilize payer websites as needed in the execution of daily tasks

Requirements

• PC skills and keyboarding
• Working knowledge of 10 key, typing and computers
• Proficiency in Microsoft Office
• Ability to type and key accurately
• Problem solving skills
• Written and 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

Qualifications

• Experience in the healthcare setting or educational coursework; One (1) year experience in physician's office or hospital setting preferred.

Nice to Have

• Knowledge of insurance billing and collections and insurance guidelines
• Knowledge of ICD-9, ICD-10, CPT and HCPCS codes
• Certification and/or degree in Healthcare Administration Business, Finance or related fields

Skills

* Required skills