Healthcare Insurance A/R Representative III’s are responsible for problem resolution and payment collection of complex billing transactions. Utilizes expert problem solving skills to resolve complex billing issues, unpaid claims, and customer complaints, taking all steps and coordinating corrective action of a multi-functional nature to ensure full resolution of prompt payment.
1. Handles correspondence related to insurance or patient account, contacting insurance carriers, patients and other facilities as needed to get maximum payment on accounts and identify issues and corrective action to be taken.
2. Identifies trends taking action to help prevent reimbursement issues and delinquent accounts. Utilize the identified trends and pattern recognition to identify defects and eliminate them at the source. Collaborate with leads and other key stakeholders to make solution recommendations.
3. Utilizes expert problem solving skills to resolve complex billing issues, unpaid claims, and customer complaints, taking all steps and coordinating corrective action of a multi-functional nature to ensure full resolution of prompt payment.
4. Researches and resolves accounts appearing on Delinquent Insurance Report, Collection Ledger and Government Payor report independently making appropriate decisions on accounts to be worked to maximize reimbursement.
5. Examines all documents to ensure bills are compliant. Determines appropriate steps and communicates critical information to insurance companies, patients, and leadership both verbally and in writing, to ensure concerns are resolved in a timely manner and accounts are settled in full.
6. Communicates with carriers, patients, other facilities, and management of all levels as needed to get maximum payment/resolution on accounts and identifies / resolves issues or changes to achieve client profitability.
7. Acquires knowledge of payor fee schedules and denials.
8. Provides on the job training to others, performing quality audits, and providing performance feedback.
9. Demonstrates in-depth understanding of insurance plans and benefit structures in order to obtain detailed benefit information and maximize plan benefits.
10. Demonstrates in-depth understanding of Medicare, Medicaid and private payors, policies and guidelines.
11. Assists in work distribution to ensure high levels of productivity and critical thinking by providing operational support, training others, and conducting audits on work quality.
12. Acts as first point of contact on technical, procedural, and policy questions. Keeps team informed of new processes and general updates.
13. Prepare members of team to identify issue areas, first applying effective problem solving skills and as necessary appropriately escalating issues.
14. Works aging reports of unpaid claims to resolve claims.
15. Works complex projects and assignments requiring advanced knowledge and experience in insurance accounts receivable.
16. Assists as needed to perform other related duties and special projects as required.
1. Knowledge, Skills, and Experience
a. Excellent understanding of the A/R process.
b. Proficient in 10 key and alpha/numeric data entry.
c. Proficient in Microsoft Office Suite, specifically Word, Excel, Outlook, and general working knowledge of Internet for business use.
d. Strong insurance billing knowledge.
e. Ability to work in a fast-past, deadline driven environment.
f. Drive for Results (Service, Quality, and Continuous Improvement) – Ensure procedures and processes are in place that lead to delivery of quality results and continually reassess their effectiveness to achieve continuous improvement.
g. Communication – Proficient verbal and written communication skills. Willingness to share and receive information and ideas from all levels of the organization in order to achieve the desired results.
h. Teamwork – Commitment to the successful achievement of team and organizational goals through a desire to participate with and help other members of the team.
i. Customer Service Focus – Demonstrate a focus on listening to and understanding client/customer needs and then delighting the client/customer by exceeding service and quality expectations.
2. Education, Certification/Licensure, and/or Experience
a. High School Diploma or equivalent required.
b. Demonstrated knowledge of ICD -9/CPT codes.
c. Four to seven years of relevant work experience in collections and healthcare billing/admissions/customer service environment.
3. Physical Demands
a. Must possess ability to sit and/or stand for long periods of time.
b. Must possess ability to perform repetitive motion.
c. Ability to lift up to 15 pounds.
d. Majority of work is performed in a desk/cubicle environment.
a. Willingness to work shift work and overtime is required.
b. Travel Required (Highlight One): Rarely Occasionally Frequently
c. Weekends/Evenings/Holidays (Highlight One): No Yes, please explain this position may require weekend, evening and holiday work.
This job description reflects management’s assignment of essential functions. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.