Rcm Ar Specialist Job in Mindpool Technologies Limited

RCM AR Specialist

The primary purpose of this role isresponsibility for the overall recovery and management of accounts receivable as it relates to maximizing collections for clients. The position involves detailed research and follow-up on medical insurance claims and the careful preparation of appeals and responses to efficiently interact with insurance carriers and resolve the claim. The position supports the company s overall Operations and Client Services by efficiently and effectively driving the accounts receivable process and showing results.

Responsibilities

• Timely management and resolution of unpaid claims as assigned
  
• Effectively manage complex payer denials by assimilating and submitting:
  
• Supporting client clinical documentation
  
• Payer criteria
  
• Correct coding guidelines
  
• Specialty Association recommendations
  
• Federal/local regulatory guidelines
  
• Supporting letter of medical necessity from the provider of service
  
• Appeal letter consistent with payer requirements
  
• Other documentation as applicable
  
• Timely resolution of denials including follow up with payers and clients
  
• Responsibility for information necessary to resolve claims is the responsibility of the AR representative.
  
• Consistent and timely follow up with the client to provide clarification and/or missing information is critical.
  
• Adherence to the Client Adjustment Authorization matrix using appropriate adjustment codes to ensure clean AR
  
• Secondary claims management
  

Monitoring and reconciliation of claims to include:

o Held vouchers

o Unbilled vouchers

o Patient balance report

o Credits and refunds

• Compliance with and enforcement of ASRCMS policies and procedures and Client specific billing guidelines
  
• Achieve goals set forth by supervisor regarding error-free work, transactions, processes and compliance requirements
  
• Specific goals include 1,400 accounts worked per month
  
• Other duties as assigned
  

Qualifications

Experience/Training/Education:

• High School Diploma or GED
  
• 2+ years of physician billing experience required
  
• Experience on the Epic or Allscripts practice management solutions is preferred
  

Knowledge/Skills/Abilities:

Technical: Extensive knowledge on use of email, search engine, Internet and Microsoft products such as Outlook, Word and Excel; ability to effectively use payer and government websites.

Personal: Strong written, oral, and interpersonal communication skills; Ability to present ideas in business-friendly and user-friendly language; Highly self-motivated, self-directed, and attentive to detail; team-oriented, collaborative; ability to effectively prioritize and execute tasks in a high-pressure environment. Time management skills are critical.

Communication: Ability to read, analyze and interpret complex documents. Ability to respond effectively to sensitive inquiries or complaints from associates and clients. Ability to speak clearly and to make effective and persuasive arguments and presentations to senior management. Ability to write reports, business correspondence, financial forecasts and budgets.

Math & Reasoning:

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent, and to interpret financial reports and graphs. Ability to use critical thinking skills to apply principles of logic and analytical thinking to practical problems.

Physical and Environmental Elements:

Physical demands: Ability to sit continuously for up to 2/3 of normal work shift. Ability to stand, walk, stoop, kneel, crouch or crawl, and to reach with hands and arms occasionally. Ability to talk and to hear continuously. Finger dexterity is required frequently for up to 1/3 of the normal work shift.

Vision: Ability to see at close range (20 inches or less), at a distance (clear vision at 20 feet or more), ability to identify and distinguish colors, ability to observe an area that can be seen up and down or to the left and right while eyes are fixed on a given point, three-dimensional vision, ability to judge distances and spatial relationships, and ability to adjust the eye to bring an object into sharp focus.

Work Environment: Employees work in an office with moderate noise levels (such as computers and printers) and controlled temperature conditions. Employees may occasionally operate a vehicle and be exposed to traffic conditions that may include loud noises, fumes, and traffic congestion.