Accounts Receivable Specialist – RCM

Role Overview

• Collecting outstanding accounts receivable from third party payers
• Performing advanced level work related to denial management
• Processing and following up on all appeal types at an expert level
• Taking actionable steps to resolve open claims
• Working outstanding accounts receivable from assigned projects
• Functioning as an SME across multiple workflows and various payers
• Providing peer payer and system training support
• Identifying denial patterns and escalating to management
• Making recommendations to work queues and claim edits
• Reviewing payer communications related to changes in policies
• Researching payer trends identified by offshore partners
• Identifying opportunities for process improvement initiatives
• Maintaining strictest confidentiality
• Maintaining basic proficiency with using spreadsheets
• Maintaining productivity and quality standards established by RCM

Requirements

• High school graduate or equivalent
• Associate or bachelor’s degree in business administration or related field of study preferred
• Minimum of 3 years accounts receivable experience preferred
• Excellent verbal and written skills
• Basic math skills for calculating anesthesia units
• General understanding of medical terminology
• Advanced knowledge of insurance processing and payer policies
• Knowledge of commercial payer, Medicare, and Medicaid guidelines
• Data entry skills with high accuracy
• General knowledge and understanding of CPT, ICD-10, and ASA codes
• Good problem-solving skills
• Decision making ability with sound judgment
• Strong analytical skills and attention to detail
• Ability to work effectively with all team members
• Must be able to work in a virtual team environment
• Ability to work independently with limited supervision
• Computer application skills to include MS Word, MS Excel, MS Outlook, and MS Teams

Benefits

• Eligible for a quarterly bonus
• All other duties as assigned