- Promptly identify any errors or other issues in claims processing.
- Effectively following up on any unpaid balances.
- Expeditiously bring any remaining balance to resolution.
- Meet quality assurance and productivity standards by identifying and reconciling insurance balance accounts.
- Identify denial trends and provide potential solutions while analyzing patient accounts utilizing our EPM system - Nextgen to determine appropriate action.
- Review explanations of benefits details on denials.
- Communicate with insurance payer representatives, patients, and TOA staff to ensure timely and accurate resolution of account transactions. This would include Commercial plans, Medicare/Medicare HMO plans, Medicaid/Medicaid HMO plans, and BCBSTN.
- Prioritize assigned accounts to maximize aged accounts receivable resolution.
- Review the explanation of benefit (EOB) documentation and notate accounts on collection activity to perform account resolution.
- Operate within established guidelines and protocols, including providing backup documentation for our accounting and audit functions.
- Collaborate closely with the Central Business Office, clinical colleagues, and administrative teammates to develop a cohesive, high-performing team.
- Adhere to HIPAA and OSHA safety guidelines.
- Exceptional customer service and patient focus.
- Knowledge of Insurance - particularly coordination of benefit rules and denial overturns are essential to this position.
- Knowledge of administrative and clerical procedures.
- Accustomed to using mostly payer websites for appeals/reconsiderations, medical records attachments, verification of benefits, and/or web-based claims follow-up.
- Ability to communicate and work as a team.
- Demonstrated proficiency with Microsoft Office programs such as Excel, Word, and Outlook.
- At least 3 years insurance collections experience.
- Experience using NextGen.
- Orthopaedic specialty experience.
- Fluency in English is required; Fluency in a second language is a plus.
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AR Specialist - Knoxville, United States - Tennessee Orthopaedic Clinics
Description
ABOUT TOATennessee Orthopaedic Alliance is one of the nation's largest orthopedic networks. TOA offers comprehensive medical and surgical treatment of bone, joint and soft tissue disorders. Our treatment is compassionate, conservative and prompt, providing patients with the specialized orthopedic care they deserve.
There are numerous reasons why TOA is an employer of choice; here are a few of them:
•Stability and Growth - TOA promotes long-term employment in positions as well as growth opportunities for those who want to further their career goals.
•Impact - TOA's team members use our careers - whether in our clinics or our business office - to make a positive difference in the community by building relationships and positively impacting patient lifestyles.
•Work Environment - The TOA team focuses on cultivating an excellent working environment; one of positivity, collaboration, job satisfaction, and engagement.
•Total Rewards - TOA offers competitive salaries based on the current East Tennessee wage market, plus a comprehensive benefit package, including Medical, Dental, Paid Time Off, Extended Illness Bank and more. Our 401(k) plan provides a company match, safe harbor match and profit-sharing match to go along with your contributions.
JOB SUMMARY
The AR Specialist is an essential part of the TOA Central Business Office. As an AR Specialist, you will use your analytical, financial, and customer service skills to ensure that TOA claims filed to an insurance payer are processed accurately and in a timely manner. This is a non-exempt full-time role with remote working possibilities.
DUTIES AND RESPONSIBILITIES
