Job Description

JOB SUMMARY:
The Accounts Receivable Representative 1 manages the accounts receivable in accordance with compliance, regulatory and billing guidelines and specific payer rules. Responsible for collection of outstanding receivables. Responsible for the accurate billing of insurance claims by validating coverage, resolving charge review edits, claim edits and front end clearinghouse and payer rejections. In addition, follows up on outstanding receivables, completes basic appeals, answers, documents and completes inquiries from patients, insurance companies, attorneys, public agencies, internal departments and 3rd party payers.

EDUCATIONAL REQUIREMENTS
None Required

CERTIFICATION & LICENSURE REQUIREMENTS
None specified

EXPERIENCE REQUIREMENTS
One-year experience in health care preferred. General computer knowledge related to Microsoft Office applications such as Word, Excel and Outlook. Proficient in the use of office based technology i.e. computer, copier, fax, scanner, etc.

SKILLS AND KNOWLEDGE
Strong written and oral communication skills; displays a high standard of confidentiality; ability to deal with a large volume of work and the ability to multitask. Maintains a comprehensive working knowledge of assigned payer billing policies and guidelines. Works proficiently within multiple revenue cycle billing systems; attention to detail; ability to prioritize and complete tasks under demanding conditions; ability to easily accept and implement change. Must demonstrate tact and diplomacy in all interpersonal interactions.

ESSENTIAL FUNCTIONS:

• Identifies and resolves billing and insurance set up errors to facilitate accurate and timely billing.
• Resolves charge review edits, claim edits and clearinghouse and payer rejections to facilitate accurate billing.
• Submits claims for assigned payers, including corrected and voided claims.
• Works patient, account, and follow-up work queues to perform collection activities on outstanding receivables; contacts patients, payers, attorneys or employers via phone, website/web portal or mail.
• Reviews and resolves incoming correspondence.
• Resolves underpayments, no payments, overpayments and undistributed payments for proper allocation.
• Identifies, prepares and requests adjustments.
• Responds to inquiries from patients, insurance companies, public agencies, internal departments and 3^rd party payers.
• Prepares, completes and follows up on designated payer reports and forms.
• Performs other duties as assigned.