Accounts Receivable Specialist - Philadelphia, United States - Public Health Management Corporation

Public Health Management Corporation

Verified Company

Philadelphia, United States

1 week ago

Posted by:

Mark Lane

beBee recruiter

Description

JOB DESCRIPTION:

Uphold the mission of the organization by evaluating, reviewing, and collecting on account receivable claims for the Network.

The AR Specialist will partner with the billing and financial management staff to ensure the timely and accurate collection of receivables and the reporting and tracking of uncollectible or un-billable services.

Team members are expected to uphold the health centers and organization's mission by assuring that patients receive health care that is competent, caring, and meets with a high degree of satisfaction.

AGE/PATIENT POPULATIONS SERVED:

Age of Patient Population Served

Neonate (birth - 28 days)

_ _Infant (29 days - less than 1 year)**
_ _Pediatric yrs.)**
_ _Adolescent yrs.)**
_ _Adult yrs.)**
_ _Geriatric (65 yrs. & older)**
_ _Nonage Specific Task (N/A)**
Population

Bariatric Patients:
BMI greater than 40, or greater than 35 with weight-related comorbidities

_ _Patient with exceptional communication needs**
_ _Patient with developmental delays**
_ _Patient at the end of life**
_ _Patient under isolation precautions**
_ _All Populations**
ESSENTIAL DUTIES AND RESPONSIBILITIES

Provide oversight and review of aged accounts receivable; make inquiries; collect on open receivables, document, and communicate collection issues or concerns.

A review of AR accounts includes the following:

Responsible for the review and resolution of insurance denials in Epic OCHIN.
Resolve denials received from individual payers, as assigned by Supervisor.
Work with internal departments to gather and appeal denials with all necessary information.
Appeal denials with an eye towards process improvement to reduce future denials.
Identify accounts with outstanding balances requiring resolution.
Ensure accurate and timely follow up of unpaid accounts.
Followup with third party payers within specified time frames to ensure timely and proper reimbursement.
Establish follow up work queue monitoring controls to assess accurate and timely follow up and prevention of thirdparty denials.
Actively participate in regularly scheduled Team meetings
Provide insight into daily work responsibilities and current trends/issues to immediate supervisor.
Report any denial issues in a timely manner to Supervisor.
Report any problematic workflows and develop workarounds for possible resolution.
Remain up to date on departmental procedures, payer contracts and insurance billing regulations.
Identify payer trends relating to payer or organizational barriers to cash
Analyze clinical activity in determination of payment.
Consistently meet productivity targets and quality assurance guidelines established by the Billing department.
Keep abreast of contract terms, regulations and receivable changes.
Identify and report payer specific trends resulting in incorrect reimbursement by monitoring rejected claims and underpayments.
Keep current with insurance regulations and ongoing changes.
Keep current with payer contract changes.
Identify issues related to contract management system.
Document all actions in Epic OCHIN system for billing, follow up, and reporting purposes
Other duties as assigned by Management.
Knowledge of medical terminology, ICD10, CPT, and HCPCS coding
Knowledge of dental terminology, CDT coding
Timely submission of adjustments and writeoffs
Partner with management to understand and contribute to the review of payer contracts or regulations impacting the billing for services and assists with payer billing compliance audits
Strong organizational skills, ability to multitask, and managed multiple priorities to meet deadlines.
Other duties as determined by the Billing Supervisor or Revenue Cycle Director.

PHMC COMPLIANCE RESPONSIBILITIES:

Understands and adheres to PHMC compliance standards as they appear in the

PHMC:
Code of

Conduct, Whistle Blowers, and Conflict of Interest Policies
Keeps abreast of all pertinent federal, state, and PHMC regulations, laws, and policies as they presently exist and as they change or are modified
Comply with the Department of Public Health (DPH), The Joint Commission, and other accreditation and regulatory agencies' standards
Adhere to all PHMC Policies and Procedures
Knowledge and adherence to Infection Control and Environment of Care Guidelines and Procedures as described in the annual education module

JOB REQUIREMENTS:

To perform this job successfully, an individual must perform each essential duty satisfactorily. The requirements listed below must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

SKILLS: