Accounts Receivable Rep - 3rd Party AR Rep

The 3rd Party Accounts Receivable Representative is responsible for preparing, submitting and following up on Healthcare claims to ensure timely reimbursement, eligibility verification, and working claim denials.

• Prepare, edit and submit account billing in accordance with payer guidelines.  Ensure all claims issues are resolved and submitted accurately and timely per insurance guidelines.
• Follow payer contract guidelines set forth for specific payers. 
• Analyze and review reimbursement rates to ensure proper reimbursement is being made based on fee schedules and contracted rates.
• Review and understand payer denials and identify payer trends.
• Verify patient’s insurance eligibility.
• Submit system payer/fee schedule changes when required to supervisor.
• Submit all required documentation with claim. Updates patient demographics changes and performs required rebilling. Requests necessary documentation when missing from client, physician or patient as appropriate.
• Respond to verbal and written insurance or responsible party inquiries regarding account status within policy and procedure timeline.  Research accounts and document follow up appropriately.
• Resolve account discrepancies and prepare adjustments and refunds for approvals as necessary.
• Maintain accurate and complete records concerning billing activity on all accounts.  Document in the system records.
• Address problems as they occur.  Keep supervisor advised of area or compliance issues which may lead to untimely or inaccurate completion of invoice or claim submission.
• Heavy Phone Calls to payers to understand denials and trends
• Complete all reports according to schedule.
• Perform other tasks as assigned to support the goals of the organization.
• To be able to work independently.
• At this time this position will work remote from home due to COVID-19 however this position may return to the business office.
• To work remote, you will need high speed internet and be able to pass speed test. 

Qualifications Skills Required Medical Terminology Intermediate Computer Skills Advanced Identify/Resolve Problems Intermediate Typing Skills - 10 Key Novice Communication Skills Advanced Customer Service Advanced Microsoft Office Some Knowledge Typing Skills Min 35 wpm Intermediate Claims Processing Intermediate Time Management Intermediate Preferred Analysis Novice Behaviors Required Thought Provoking: Capable of making others think deeply on a subject Enthusiastic: Shows intense and eager enjoyment and interest Team Player: Works well as a member of a group Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well Experience Required Blue Cross CMS1500 Claim Processing HealthCare Accounts Receivable Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
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