01Overview
Overview
- The Denials Specialist (Accounts Receivable (AR) Specialist) is primarily responsible for analyzing collections, resolving non-payables, and handling bill inquiries for more complex issues. AR Specialists are responsible for insurance payer follow-up ensuring claims are paid according to client contracts. Complies with all applicable laws regarding billing standards.
Responsibilities
- Follows up on claim rejections and denials to ensure appropriate reimbursement for our clients.
- Process assigned AR work lists provided by the manager in a timely manner.
- Write appeals using established guidelines to resolve claim denials with a goal of one contact resolution.
- Identified and resolved denied, non-paid, and/or non-adjudicated claims and billing issues due to coverage issues, medical record requests, and authorizations.
- Recommend accounts to be written off on Adjustment Request.
- Reports address and/or filing rule changes to the manager.
- Check the system for missing payments.
- Properly notates patient accounts.
- Review each piece of correspondence to determine specific problems.
- Research patient accounts.
- Reviews accounts and determines appropriate follow-up actions (adjustments, letters, phone insurance, etc.).
- Processes and follows up on appeals. Files appeals on claim denials.
- Inbound/outbound calls may be required for follow-up on accounts.
- Respond to insurance company claim inquiries.
- Communicates with insurance companies about the status of outstanding claims.
- Meet established production and quality standards as set by Ventra Health.
- Performs special projects and other duties as assigned.
Qualifications
- High School Diploma or GED.
- At least one (1) year in the data entry field and one (1) year in medical billing and claims resolution preferred.
- AAHAM and/or HFMA certification preferred.
- Experience with offshore engagement and collaboration desired. .
