Specialist-Accounts Receivable Follow Up

About the Role

The Accounts Receivable Follow Up Specialist performs collection and follow-up activities with third-party payers to resolve outstanding balances and ensure accurate and timely adjudication. This role is responsible for net and gross outstanding accounts receivable, the percentage of accounts aged over 90 days, cash collections, and denial resolution, supporting team efforts to achieve accounts receivable performance goals. The Specialist handles daily activities for the successful closure of aged accounts receivable.

Key Responsibilities

• Performs online account status checks and contacts payers to follow up on outstanding claim balances for assigned accounts in work queues.
• Clearly documents patient account notes, payment status, and/or actions taken to secure payment in the EMR system.
• If applicable, requests account for additional follow-up activity within prescribed days according to payer-specific filing requirements or processing times.
• Performs required actions to resolve account balances promptly by submitting appeals, correcting account information, coordinating medical record requests, posting account adjustments, requesting account rebills, and any other necessary actions to secure payment or bring the account to closure.
• Documents, tracks, and ensures reasonable turnaround time for the receipt of outstanding documents from external departments.
• Responds to claim denials from payers (e.g., inability to identify the patient, coordination of benefits, non-covered services, past timely filing deadlines) and ensures all information is provided.
• Documents all actions taken on accounts in EMR system account notes for clarity and understanding of prior actions.
• Informs the supervisor of problems or changes in payer requirements.
• Exercises independent judgment to analyze and report repetitive denials for corrective action.
• Achieves established productivity and quality standards as determined by the Baptist Productivity and Quality Expectations.
• Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines impacting patient account collections.
• Adheres to internal controls for applicable state/federal laws and program requirements of accreditation agencies and health plans.
• Seeks advice and guidance as necessary for proper understanding.
• Effectively utilizes payer websites for daily tasks.
• Conducts account claim status and follow-up, and resolves claim payment denials.
• Monitors assigned work queues from all sources, ensuring expeditious resolution by collaborating with other departmental representatives.
• Reports unresolved issues and concerns that impede the collection process to ensure successful account resolution.
• Complies with patient confidentiality policies for the retention, handling, distribution, or disposal of patient health information.
• Performs other duties as assigned by the Supervisor.

Requirements & Tech Stack

• PC skills and keyboarding
• Working knowledge of 10 key, typing, and computers
• Proficiency in Microsoft Office
• Ability to type and key accurately
• Problem solving skills
• Written and oral communication skills
• Financial counseling skills
• Knowledge of insurance billing (hospital and professional settings) and collections
• Knowledge of insurance guidelines as they relate to CMS guidelines, TennCare, and/or Medicaid based on state-specified requirements
• Ability to recognize and communicate to clinical staff or designee when insurance companies require additional review due to NCCI, CCI, LMRP, Mutually Exclusive, and Medical Necessity edits.
• Effective Verbal, written, and customer service skills as it relates to patients and insurance companies.
• Ability to create communications for patients and insurance companies to resolve issues and complete billing/claim processes.

Qualifications

• Experience in the healthcare setting or educational coursework
• One (1) year experience in a physician’s office or hospital setting (Preferred/Desired)
• Knowledge of insurance billing and collections and insurance guidelines (Preferred/Desired)
• Knowledge of ICD-9, ICD-10, CPT and HCPCS codes (Preferred/Desired)
• Certification and/or degree in Healthcare Administration, Business, Finance, or related fields (Preferred/Desired)