AR Rep Customer Service T2

Sage Clinical RCM, LLC is seeking an AR Rep Customer Service T2. This position is responsible for handling customer service phone calls related to billing inquiries and managing accounts receivable for assigned Client EMR Accounts. The role involves ensuring accurate billing, follow-up on claims, and maintaining compliance with regulations.

Responsibilities:

• Accepts and resolves incoming patient billing inquiries
• Responsible for Legal Billing release of information documentation
• Initial biller and follow up of workman’s compensation, IBCCP and liability claims
• Reviews and/or scrubs final billed initial claims for accuracy and completeness prior to submitting to payer
• Submits electronic and/or hardcopy claims with any attachments as per the contract timely filing criteria
• Documents all account activity in the hospital/client system and The Q with clear and concise notes
• Within appropriate time frames, contact the health plan by phone or website to determine status of claim
• Documents all follow-up actions in the hospital/professional account notes and sets up account for additional review based on client expectations for follow-up of unresolved accounts
• Research and validate the paid or partially paid claim status is in accordance with the expectations outlined in the client contract agreement
• Deliberately and thoroughly reviews any denied, dis-allowed, or non-covered claims / charges and determines accuracy based on contract language
• Resolves any technical issues when warranted with payer
• Follows client specific procedures to request adjustments and refunds
• Prepares appeal and necessary documentation for authorization, coding, level of care and/or length of stay denials
• Follow guidelines for prioritization and timely filing deadlines

Requirements:

• High School diploma or equivalent
• 2+ years previous experience in healthcare revenue cycle management
• Maintains compliance with regulations and laws applicable to job
• Professional level of communication with video, phone, and email
• Ability to effectively prioritize the work to meet deadlines and expectations
• Meets the quality and productivity measures as outlined by Quadris
• Brings positive energy to work
• Uses critical thinking skills
• Being present and focused on assigned tasks and eliminates distractions
• Being a self-starter
• Ability to work independently and within a team atmosphere
• Proficient application of business/office standard processes and technical applications