The Revenue Cycle AR Specialist II is responsible for resolving insurance balances, following up with payors, and submitting appeals and reconsideration requests on rejected and denied claims.
Ensures claims are paid by insurance carrier to the organization correctly.
Works receivable inventory within department standards including, as applicable: maintaining assigned list of hospital or professional accounts; documenting agreement arrangements or reasons for outstanding balances; performs collection and follow up efforts; coordinating and/or posting adjustments, contractual allowances, or refunds within levels of authority.
Identifies root causes of insurance denials. Remains current with core knowledge of specific payer policies, contracts and administrative bulletins
AR Denials Specialist at this level has a solid understanding of under payment and credit balance process.
Identifies root causes of insurance denials. Remains current with core knowledge of specific payer policies, contracts and administrative bulletins
Communicates identified payer trends such as denials for specific procedure, diagnosis codes, or other identified issues
Accurately and compliantly resolves insurance balances after payment or adjudication, and correctly identifies any patient liability (i.e., contractual/payment review, etc.) and ensures accurate resolution of account to payment or payor terms;
Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites.
Leverages available resources and systems (both internal and external) to analyze patient accounting information and take appropriate action for payment resolution; documents all activity in accordance with organization and payor policies.
Coordinate appeal when claim is denied. May partner with medical care team members on complex appeals.
Submits LOMN (Letter of Medical Necessity) and other drafted appeals and reconsiderations on rejected and denied claims.
Sends appeals to payors and follow up to ensure payment is made.
Continue to review acct and escalate as necessary if denial is not overturned.
Engages the CFC, UR, Revenue integrity or coding follow-up team for any medical necessity, auth. or coding related to denials review.
Sets follow-up activities based on status of the claim; ensure full and clear account documentation on account status within system.
Collaborate as a part of a team on special projects by utilizing excel spreadsheets, and effectively communicate results
Performs other job-related duties as assigned.
Education and/or Experience Required:
Education:
High School Diploma, GED, or a higher level of education that would require the completion of high school.
Experience:
Minimum of 3 years Billing experience required in healthcare Rev Cycle with specialization in billing, account receivable follow up and denial management, with a High School Diploma/GED
OR
Minimum of 2 years direct experience with an Associate or Bachelors
Education and/or Experience Preferred:
Education:
Associate’s Degree in Healthcare Management, Finance, or related field.
Experience:
Experience with Epic
License and/or Certification Required:
N/A