Specialist - AR

Job Summary

By embodying our core purpose of customer obsession, new ideas, driving innovation, and delivering excellence, you will help ensure that every touchpoint is meaningful and contributes to our mission of redefining the possible in healthcare.

The Accounts Receivable Specialist shall be responsible for following up directly with commercial and governmental payers to resolve claim issues and secure appropriate and timely reimbursement. Identifies and analyzes denials and payment variances and takes action to resolve accounts, including drafting and submitting technical appeals.

Job Competencies

• Valuing Differences

  - Works effectively with individuals of diverse cultures, interpersonal styles, abilities, motivations, or backgrounds; seeks out and uses unique abilities, insights, and ideas. Considers the collective.

• Collaboration

  - Works cooperatively within teams and partners with others, both internally and externally as needed, to achieve success; focuses on the results of the team, not the achievements of one person. It’s “All for One and One for All.”

• Accountability

  - Accepts personal responsibility and/or consequences of failure and successes, delivering on commitments and refocusing effort when needed. Someone willing to step up and own it.

• Time Management

  - Effectively manages personal time and resources to ensure that work is completed efficiently.

• Developing Trust

  - Gains others’ confidence by acting with integrity and following through on
• Commitments. Treats others and their ideas with respect and supports them in the face of challenges.

• Takes Initiative

  - Takes prompt action to accomplish goals and achieve results beyond what is required, is proactive, and pursues relentlessly.

Essential Job Functions

• Customer Obsession

   - Consistently provide an exceptional experience for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.

• Embracing New Ideas -

   Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.

• Striving for Excellence -

   Execute at a high level by demonstrating our “Best in KLAS” Ensemble Different principles and consistently delivering outstanding results.

• Examines denied and underpaid claims to determine the reason for discrepancies. Communicates directly with payers to follow up on outstanding claims, file technical appeals, resolve payment variances, and ensure timely reimbursement.
• Ability to identify with specific reason for underpayments, denials, and the cause of payment delay.
• Works with management to identify, trend, and address root causes of issues in the A/R.
• Maintains a thorough understanding of federal and state regulations, as well as payer-specific requirements, and takes appropriate action accordingly.
• Documents activity accurately, including contact names, addresses, phone numbers, and other pertinent information.
• Demonstrates initiative and resourcefulness by making recommendations and communicating trends and issues to management.
• A strong problem solver and critical thinker to resolve accounts.
• Must meet productivity and quality standards.
• Performs other duties as assigned.

Education, Certifications & Experience

Bachelor’s degree in any discipline

• 1 - 3 years of experience in medical collections, physician/hospital operations, AR Follow-up, denials & appeals, compliance, provider relations, or professional billing preferred.
• Good analytical skills and proficiency with MS Word, Excel, and PowerPoint.
• Good communication Skills (both written & verbal).
• Good knowledge of US healthcare, Revenue Cycle Management.
• The candidate should know about Medicare and Medicaid.
• Ability to interact positively with team members, peer groups, and seniors.
• Preferred Certified Revenue Cycle Representative (CRCR).