Accounts Receivable-Insurance Payment Posting

GENERAL JOB DESCRIPTION: 

Medical AR specialist responsible for handling patient financial accounts including review and posting of checks, EFT’s, ERA’s, patient inquiries, reconsideration of denied claims, EOB’s, documentation review and claims corrections. Needs an aware of insurance contract requirements and detailed attention on each processed claim for discrepancies. Field incoming patient phone calls and assist with understanding policy benefits and claims processing. If necessary, contact the insurance company to assist with patient claim disputes.

Optimizes patient care by using effective customer service communication skills including kindness, tact and courtesy to ensure positive patient response/experience.  Demonstrates proactive interpersonal communications skills when relating to internal and external customers.  Uses discretion, exhibits professional conduct and abides by the policy protecting confidentiality.  Demonstrates problem solving skills and pro-active resolution.  Attempts to handle problems/conflicts independently and with a sense of urgency.

QUALIFICATIONS FOR THE JOB: 

Education:

• High school diploma/GED or equivalent working knowledge

Experience:

• 2 Years front office or customer service experience in a medical or other setting
• Medical front office or insurance billing experience helpful

KEY COMPETENCIES:

• Ability to perform basic math functions.
• Ability to handle confidential information and sensitive issues.
• Work under minimal supervision and make independent decisions using good judgment.
• Excellent communication and human relations with various backgrounds and diverse populations, utilizing necessary resources when language barriers are present.
• Proficient in basic computer functions and programs.
• Keen attention to detail and strong organizational skills.
• Ability to multitask and reconcile accounts in a timely manner.
• Performs efficiently exhibiting good analytical and problem solving skills.
• General understanding of coding guidelines, requirements and methodologies.

RESPONSIBILITIES:

• Review all insurance EOB’s and payments for accuracy according to patient benefits and office contract.
• Post insurance checks, EFT’s and ERA’s, making sure that insurance adjustment and patient balances are correct.
• Uses the correct journal for payment posting; verifies all funds have been allocated.
• Review claim denials – follow individual insurance protocol for any claims that need correction. If a claim denied incorrectly begin the process of review and reconsideration of the claim.
• Check and work Claim Control daily for clearinghouse rejections.
• Review Claim Control weekly for denials, timely and past due claims and make appropriate follow up calls.
• Field incoming patient phone calls and assist with understanding policy benefits and claims processing. If necessary, contact the insurance company.
• Assists patients with lab issues and directs them to the correct outside sources as necessary.
• Take patient payments over the phone and apply to balances.
• File formal appeals when appropriate.
• Monitor the Patient Balance task group as assigned and respond in a timely manner.
• Assist the front office with patients - answer questions regarding any patient accounts.
• Available to assist coworkers with questions or other issues as necessary.
• Conveys a warm and calm phone demeanor at all times; speaks to the patient with a “smile”.
• Warm transfer of all patient phone calls to different departments.
• Uses discretion, exhibits professional conduct and abides by HIPAA.
• Performs other related work as requested/directed by management.
• Attends all regular staff meetings.