AR Specialist Hospital - Full-Time Work From Home Opportunity

Position: AR Specialist

FLSA Status: NON-EXEMPT

Location: Work from Home Opportunity

Job Summary: This position is responsible for Billing, Re-Billing, Post-payment and Account Follow-up and/or grievance preparation of assigned Client Hospital Accounts Receivable. Working in a remote environment the responsibilities may include account maintenance of specialized or multiple payers including state and federal government programs, managed care, commercial and other insurance groups. The AR Specialist may serve as a liaison to clinical auditors, other team members, hospital staff, government agencies and health plans to facilitate the appropriate and prompt payment of claims. Responsibilities may also include provider payer enrollment.

This individual must demonstrate a commitment to the organizations strategic plans, short- and long-term goals and mission, vision and values by representing the company in a caring and professional manner.

Primary / Essential Functions:

The Primary responsibilities and essential job duties effectively and efficiently performed include but are not limited to the following:

BILLING

• Reviews and/or scrubs final billed initial claims for accuracy and completeness before submitting for payment.
• Obtains necessary patient records required as attachments to claims.
• Calculates Tier, Outlier, DRG and/or other Fee Schedule based reimbursement.
• Submits electronic and/or hard-copy claims with any attachments as per the contract timely filing criteria.
• Documents all account activity in the hospital system notes and the database.

INSURANCE FOLLOW-UP

• Within appropriate time frames, contacts the health plan by phone or website to determine status of claim.
• Documents all follow-up actions in the hospital or provider account notes and database and sets up account for additional review based on client expectations for follow-up of unresolved accounts.

POST PAYMENT REVIEW

• Researches all account information on paid or partially paid claims and analyzes the status of the payment related to the expected payment calculation and itemization provided by the remittance advice.
• Determines if payment is appropriate according to contract specifications.
• Analyzes any denied, disallowed or non-covered claims and determines if non-payment is based on medical or technical reasons.
• Resolves any technical issues when warranted with health plans via phone or website.
• Prepares requests for account balance adjustments in accordance with client specific procedures.
• Prepares claims for clinical audit processing in the case of authorization, coding, level of care and/or length of stay denials.
• Processes over-payment transactions in accordance with client specific procedures.
• Follows guidelines for prioritization, timely filing deadlines, hospital and database documentation.

PAYER ENROLLMENT

When assigned, the role may also include the following payer enrollment responsibilities/tasks:

• Responsible for implementation and oversight of all activities related to payer enrollment for providers.
• Responsible for development of payer enrollment policies and procedures.
• Maintains knowledge of facility and payer credentialing requirements.
• Prepares reports from credentialing database and provides communication regarding credentialing status.
• Coordinates and manages the dissemination to health plans and other payers.
• Other tasks / projects as assigned by leadership.

Physical / Mental Demands, Environment:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Upon request, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions, recognizing that Quadris must work within the limitations established & based on business need and requirements.

• This position requires minimal lifting such as laptop, monitor and other company equipment as well as long periods of time in a sitting position.
• Must communicate clearly in English language. Requires the ability to speak, read, write, see, and hear to perform essential duties of the job.
• Must be able to perform multiple tasks and detailed work, problem solve, reason and perform basic mathematical calculations & essential functions required of this position outlined in this document.

Equipment Used:

Telephone, eFAX, calculator/adding machine, computer, monitor, printer, hardware and software packages, computer peripheral equipment i.e. mouse and keyboard, Microsoft software and tools and other software as required.

Competencies:

• Maintains compliance with regulations and laws applicable to job.
• Ability to effectively communicate clearly, concisely and with professionalism both in writing and verbally.
• Utilizes a variety of strategies or approaches to communicate effectively with others and all levels of staff and management.
• Ability to explain and manage priorities, goals and requirements efficiently to meet deadlines, productivity and quality expectations and business/client demands.
• Ability to prioritize and multi-task in a fast-paced environment to meet and effectively perform essential functions of this position.
• Mathematical abilities to analyze and determine claim amounts, calculate received/owed, adjustments, etc.
• Effective, professional and positive human relations skills are required, including confidentiality, in order to appropriately interface with internal staff, clients, patients and their families.

Minimum Qualifications:

• Knowledge and skills typically acquired through receipt of a diploma.
• 2+ years hospital and/or physician experience in the health care field or health care service related.
• Working knowledge of MS Office, healthcare & standard computer programs and technical applications.
• Professional and effective verbal and written communication skills are essential.
• Ability to effectively organize and prioritize to meet individual and team goals/metrics.
• Proven knowledge of insurance payers and policies to include but not limited to: Government programs, VA, Commercial, Medicare, Medicaid, BCBS, AETNA, UHC, etc.
• Ability to flex schedule as needed and manage work time effectively to meet business demands.
• Working knowledge of Athena, Meditech, CPSI, EPIC or other patient management systems.
• Ability to work effectively in a remote environment including independent thinking, requires minimal supervision, setting up a HIPAA compliant work environment (to be verified upon hire).
• HIPAA Compliance & Regulatory certification required and must remain in good-standing for continued employment.

Our company is formed on the basis of a long-term friendship and the mission of providing solutions for our clients that reflect the integrity, quality, value and service that we have provided to our colleagues and clients through our professional history. We also have a commitment to our team members to provide a work environment that reflects trust, honesty, work life balance and provides an atmosphere in which they can grow and learn.

Our team members are the core of our organization. Our team structure is not hierarchical in nature and instead built on client teams where each team member is accountable to the success of the project/client. In turn, we will build a culture of team member engagement and dedication to the mission of our services: integrity, quality, value and service.

We offer a wide variety of services that provide innovative solutions to move your business forward to include but not limited to: Consulting, Staff Augmentation, Technology Solutions, Interim Leadership and Assessments. Please connect with us at WWW.QUADRISTEAM.COM

Quadris Team, LLC, participates in E-Verify (Employment Eligibility Verification).