Commercial Insurance Accounts Receivable at Charleston

Commercial Insurance Accounts Receivable

Job Purpose: 
The Commercial Accounts Receivable Specialist is responsible for a variety of duties that may include routine billing payment posting and problem solving for commercial Insurance payers. In addition, the Specialist may be responsible for billing and posting for special contracts and for obtaining and/or entry of prior authorizations. This position is responsible for clear, detailed communication with the clinical and billing staffs, and with payers and clients regarding various insurance-related and payment-related issues. Responsibilities include researching and resolving client insurance claims that are denied or uncollected and working with the clinical staff members to resolve billing problems.

Job Duties:
Verify accuracy of billing data and revise errors.

Operate NextGen for billing, posting, and claims research.

Resolve discrepancies in accounting records.

Interact with staff, clients, payer and agencies to answer questions, obtain information, and resolve issues.

Monitor aging reports and take such steps as necessary to guarantee payment of claims.

Coordinate and collect necessary information from staff or payers for claim adjudication.

Participate in take-back, overpayment, and refund process.

Recognize problem accounts and notify appropriate staff or supervisor to assist in problem resolution.

Anticipate insurance trends and advise supervisor of changes.

Assist in the creation of manuals and protocols.

Participate in chart opening and auditing processes as needed.

Adhere to policy and procedures set companywide and inter-departmentally

Meet monthly and/or quarterly goals set by Management

Skills:

Experience with Commercial HMO/PPO billing guidelines and rules, insurance reimbursements methods, the claims appeal process, understanding of managed care contracts and capitation, experience with billing of physician commercial insurances.

Ability to read and understand HCFA regulations, HIPAA compliance, and updates with each state

A solid knowledge base regarding: regulatory compliance requirements and insurance company requirements.

Establishing and maintaining effective working relationships with other employees, patients, Providers, and the public.

Utilizing customer service when dealing with frustrated team members.

Discretion and trustworthiness due to frequent contact with confidential material

Excellent medical and insurance terminology use and understanding

Good communication skills

Attention to detail skills and high level of accuracy.

Must be dependable and take initiative.

Must have good time management and organizational skills with the ability to prioritize workload.

Must be team orientated and assist where needed.

Please email resume to:

LRichards@ nasonmedical.com

or Fax resumes to (843)-614-4107.

EOE


Country: USA, State: South Carolina, City: Charleston, Company: Nason Medical Center.