Account Resolution Specialist – Hospital
The Accounts Resolution Specialist (ARS) will investigate claims, follow up with payers, collect the insurance accounts receivable, escalate stalled claims, verify accounts sit at correct liability, and balance with payer, and identify any payer specific issues to possibly communicate to team and manager.
- Investigate, follow up with payers, and collect the insurance accounts receivables assigned by the manager.
- Perform comprehensive follow up activities that facilitate cash collections and document follow up activity in the appropriate system.
- Verify that the account sits at correct liability and balance with the payer.
- Maintain professional interaction with colleagues and client.
- Comply with Process Agreement.
- Identify any payer-specific issues and communicates to team and manager.
- Identify IPO’s.
- Participate and contribute to daily shift briefings.
- Comply with productivity standards while maintaining quality levels.
- Sharing newfound information with team and manager
Escalation of stalled claims.
- Collaborates with the team via CollabApp when questions arise and assist other team members when questions arise.
- High school diploma or equivalent.
- 1 – 5 years experience working with health insurance companies in securing payment for medical claims.
- 1 – 5 years experience with billing hospital claims (UB04) and filing appeals with Health insurance companies.
- Familiar with ICD-10 Diagnosis and procedure codes, CPT/HCPCS codes as well as value and occurrence codes.
- Understanding of how to investigate medical accounts to determine reason for non-payment and take appropriate action.
- Comfortable in both making decisions and acting.
- Positive outlook, pleasant demeanor and is willing to learn and grow.
- Open to feedback and continual performance improvement.
- Act in the best interest of the organization and the client being served.
- Mature nature with respect to his/her attitude towards work and colleagues.
- Punctual, dependable, and adapt easily to change.
- Perform work duties using ethical decision-making processes.
- Strong character demonstrating accountability and responsibility.
- A keen eye for detail and thoroughness when identifying issues and presenting solutions to resolve account problems.
- Perform other duties as assigned.
- Experience with Epic.
- Computer skills including proficiency with Microsoft Office Suite/Teams and Go ToMeeting/Zoom.
- Possess demonstrative and verifiable revenue cycle performance accomplishments.
- Extensive knowledge of rules and regulations relative to Healthcare Revenue Cycle administration.
- One year experience in medical billing or follow up.