The Accounts Receivable Specialist – Level 1 is responsible for the follow-up on all insurance claims, including resolving unpaid accounts in a timely and efficient manner for one or more geographical areas, while maintaining required quality and productivity standards.
Duties and Responsibilities:
- Review, modify, and re-bill rejected/denied claims by assigning appropriate insurance carrier, utilizing the billing address and/or payor prefix.
- Process Acccounts Receivable items in queues within appropriate timeframes, (e.g. claims status checks, appeals of denied claims).
- Recode private pay, commercial insurance and HMO claims, assign proper condition codes/ICD-9 codes/procedure codes into the Accounts Receivable Billing System and re-file claims as necessary.
- Create narrative in the Accounts Receivable Billing System to document status of trip for use in claim appeal process.
- Ensure that charges are billable to a particular commercial payor, based on the payor’s criteria, as needed.
- Resolve payment issues with carriers, (e.g. denials, partial payments, etc).
- Appeal claims as necessary.
- Process incoming correspondence, including signature letters, denials and additional information necessary to release the claim.
- Forward credit card payments to Cash Posting as required.
- Review the Level of Service to be billed, including but not limited to, designating Advanced Life Support (ALS), Basic Life Support (BLS), Wheelchair, or Specialty Care Transport (SCT)/Critical Care Transport (CCT).
Knowledge and Skills (not required but helpful):
- ICD-9/ICD-10 coding/condition codes and procedure codes
- HIPAA Requirements
- Flexible with shifting daily priorities
- Meet deadlines working within tight time constraints
- Handle a large volume of work and/or phone calls
- Prioritize workflow
- Process clean claims for one or more geographical areas and/or financial classes
- Meet or exceed and sustain all established standards for productivity and quality
- High School Diploma or GED required
- Minimum one (1) year previous medical insurance follow-up or related office work experience required. Ambulance billing experience a plus.