AR Specialist II

Epic Care is looking to add an AR Specialist II to our team!

The AR Specialist will be responsible for investigating aged insurance claims to determine appropriate action and provide resolution; by determining payment status using account notes, health plan websites and health plan customer service. Determines and facilitates appropriate action for claim resolution and correct financial responsibility via DOFRs, IPA and health plan contacts. Maintaining timely follow-up to ensure claims are corrected/rebilled/appealed within carrier filing limits. Effectively uses detailed documentation in EPM system(s) of all activities undertaken. Help to identify aged claim patterns to identify potential process improvements. Ability to multi-task and comfortable changing priorities as needed. Strong MS Office capabilities, including but not limited to Word, Excel and Outlook. Demonstrated ability to work well in a team environment. Assists in mentoring department personnel, assisting with questions/clarifications.

Multi-Specialty Billing experience required

Maintains timely follow-up on outstanding insurance claims in appropriate EPIC WQs, ensuring claims are billed/rebilled within carrier filing limits

Effectively takes appropriate action on claim denials to ensure prompt resolution and follows-up on those rebilled, corrected and appealed

Maintains detailed documentation in software system(s) of all claims & collections activities, including rebills, all follow-up, and related correspondence with carriers, practitioners

Call healthcare insurance companies, their affiliates & providers to resolve any question about contract or payment issues

Informs Supervisor of problems related to insurance company payments/denials, contract pricing, and works with Supervisor and all parties involved to ensure prompt resolution

Strong MS Office capabilities to include Word, Excel and Outlook

Demonstrated ability to work well in a team environment

Ability to multi-task in a fast-paced work setting

Meet or exceed production, quality and accuracy standards while ensuring privacy and documentation procedures are maintained

Meets or exceeds monthly A/R targets

Must have 1-2 years EPIC experience

Must have DoFR experience

Work collaboratively with leadership and other team members to improve or challenge processes, provide trending and solutions insights and support the capability development of the team

Investigate all insurance payments that deviate from expected payment (ie: underpayments, contracting issues)

Assist in mentoring unit personnel, training, or re-training staff and assisting with onboarding of new personnel.

May be required to attend conference calls when necessary.

Will be responsible for maintaining spreadsheets assigned by Supervisor

EDUCATION / TRAINING REQUIREMENTS

GED / Diploma - High School REQUIRED

2 Years - Business Admin / Healthcare / Related Field PREFERRED

LICENSES / CERTIFICATIONS / REGISTRATION/ EXPERIENCE

Certified Medical Reimbursement Specialist CMRS - PREFERRED

Certified Medical Insurance Specialist CMIS - PREFERRED

3 years Billing in Medical Office / Hospital - REQUIRED

3 years CPT/ICD-10 guidelines and use of modifiers - REQUIRED

1 year Excel and other Microsoft office applications - REQUIRED

1 year EMR - REQUIRED

2 years EPIC EMR - PREFERRED

2 years Division of financial responsibility (DoFR) experience - PREFERRED