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AR Representative at Envision Healthcare

Posted in Other 30+ days ago.

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Type: Full Time
Location: Dayton, Ohio

Job Description:

Open AR Representative position

Summary:

AR Specialist Team Member is responsible for ensuring timely reimbursement for hospital billed claims. Minimum 5 years of hospital collections experience required. Knowledge of Commercial, Third Party Insurance Accounts including but not limited to Medicaid, Managed Care, HMO, PPO, Auto and Work Comp. Rules and Guidelines governing collection activities. Working accounts in a computerized automated environment.

Essential Duties and Responsibilities:

* Conducts appropriate account activity on final billed claims by contacting government agencies, third party payers, and patients/ guarantors via phone, email, or online.

* Timely follow-up on all accounts assigned, work accounts as established procedures until account is resolved, sent to legal, or disputed.

* Validate denial reasons and ensures coding is accurate and reflects denial reasons.

* Generate an appeal based on the dispute reason and contract terms specific to the payor. This includes online reconsideration.

* Responsible for maintaining inventory on desks with no backlog.

* Ensures proper account documentation which is clear, concise and includes all pertinent information.

* Daily calls to payers to obtain payment resolution and account status information

* Consistently follows established processes and procedures for all assigned accounts and projects to ensure prompt payments and account resolutions

* Makes appropriate and necessary corrections to patient account information as needed to ensure timely payment.

* Follow specific payor guidelines for appeal submission.

* Research contract terms/ interpretation and compile necessary supporting documentation for appeals.

* Immediate and appropriate escalation of payor trends and issues to management which impact cash, aging and processes.

* Maintains or exceeds 95% of established productivity goals and quality standards.

* Utilizes company software in all account follow-up activities and promotes working toward paperless environment.

* Ensures professional verbal and written communication with facilities, clients and co-worker following established guidelines. Obtains management approval when necessary to communicate with external clients about internal processes and procedures.

* Follows and maintains patient, account and client confidentiality at all times. Adheres to HIPAA and Compliance Policy Guidelines.

* Follows time-keeping and attendance policy daily.

* Follows guidance of direct manager/supervisor as well as company policy.

* Seeks out assistance when needed from direct manager/supervisor.

Non-Essential Duties and Responsibilities:

* Performs other duties as assigned.

* Provides leadership to others through example and sharing of knowledge and skill.

* Complies with all company policies and procedures, including the corporate compliance program.

Minimum Qualifications:

Education/Licensing/Certification:

* High school diploma or GED required.

* Medical Billing and Coding Certificate a plus.

Experience:

* Require 5 years of hospital medical collections experience.

* Knowledge of Commercial, Third Party Insurance Accounts including but not limited to Medicaid, Managed Care, HMO, PPO, Auto and Work Comp. Rules and Guidelines governing collection activities.

Knowledge and Skills:

* Ability to communicate clearly in both written and verbal format.

* Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages. Proficiency in the use of a 10-key.

* Ability to define problems, collect data, establish facts and draw valid conclusions thru the use of critical thinking skills.

* Ability to define problems, collect data, establish facts and draw valid conclusions thru the use of critical thinking skills.

* Previous experience should include basic computer knowledge.

* Knowledge of Microsoft Word and Excel required.

* Working accounts in a computerized automated environment.

* Uses independent and critical thinking skills to achieve assigned objectives.

* Ability to organize and prioritize.

* Attention to detail.

* Ability to be accurate and timely.

* Good decision making skills.

* Ability to maintain confidential information.

* Must be able to perform the following, with or without reasonable accommodation: sit for extended periods of time; stand, walk or otherwise move occasionally; use hands to operate a telephone, calculator, computer keyboard and mouse; speak and hear in order to answer questions and resolve problems etc.; move or exert force up to 25 pounds occasionally (files, boxes of supplies, binders, etc.); have visual capability sufficient to read a computer monitor and written documents.