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Description
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AR Management Specialist
- Location Spartanburg, SC
- Facility Beaumont Mills
- Department Business Services
- Schedule - Shift - Hours Full-Time - Days - 8-5
- Job Category Administrative/Clerical
- Salary Job Grade 014
- Req #: 58355
Summary
Position Summary
The AR Management Specialist is responsible for the complete life cycle of a patient’s account. This life cycle includes a range of billing processes related to managing accounts ready to bill for all payors, including the collections and follow up for all billed services. This position is also responsible for all denials that may occur after billing, including working with patients and clinicians to resolve and appeal those denials. This position is responsible for the timely and accurate billing, as well as AR management of all patient accounts in order to meet and/or exceed our departmental goals for cash collections and AR.
Minimum Requirements
Education
- High School Diploma or equivalency
Experience
- Must have had at least 3 years electronic billing and/or billing editing experience in a hospital and/or physician office setting.
License/Registration/Certifications
- N/A
Other Knowledge, Skills, and Abilities
- Must have good knowledge of HCPCS, CPT-4 and ICD9-10 coding and/or medical terminology.
- Must be efficient in reading insurance explanation of benefits (EOB) and understanding of remittance and remark codes.
- Must be familiar with multiple payer requirements and regulations for claims processing.
- Must have solid Microsoft Office skills with a focus on Excel and Word.
- Good communication skills and the ability to courteously interact with multiple departments within SRHS.
Preferred Requirements
Preferred Education
- Healthcare related Associates or Bachelor’s degree
Preferred Experience
- 5+years billing experience in a hospital and/or physician billing setting.
- Experience in billing both technical and professional charges.
- Experience with DDE
Preferred License/Registration/Certifications
- Certified Revenue Cycle Associate (CRCA)
- Certified Professional Coder- Hospital Services (CPC-H)
Core Job Responsibilities
- Responsible for all pre-bill edits and claim scrubber edits for accuracy and compliance with all government and commercial carriers billing guidelines before releasing for submission to payers.
- Understands and adheres to state and federal regulations and system policies regarding compliance, integrity, and ethical billing practices.
- Must possess a good working knowledge of the UB04 and CMS 1500claim form and the data elements/field data required.
- Responsible to bill all services within a timely filing as defined by departmental goals and insurance guidelines.
- Must understand and comply with the rules regarding edits.
- Responsible for all billing related denials to identify trends to improve clean claim rates.
- Responsible for multiple daily reporting of billing indicators through various reporting tools
- Collections of all outstanding claims by direct payer contact, utilization of payer websites, and through EDI/Claims systems.
- Research and Resolve all payments issues/errors for insurance balances.
- Responsible to complete all error corrections and insurance updates to the facility/professional claim in order to resolve outstanding denial/issue preventing payment.
- Complete claim corrections, coding research requests, as needed to manage outstanding AR.
- Responsible for managing all retro-authorizations for multiple payers.
- Must possess the ability to work in different systems including claims eligibility, online payer claims system, case management as well as all AR management systems.
- Work closely with multiple departments to obtain necessary information to resolve outstanding AR.
- Update and verify insurance records as needed to correct outstanding accounts.
- Must have working knowledge of registration, payment posting, error correction and other billing functions.
- Manage time and job responsibilities in order to meet monthly goals.
- Responsible to review and resolve all daily claim scrubbers’ edits based on coding/billing guidelines.
- Research and resolve all outstanding denials within work cue and complete all necessary follow up within a timely and accurate manner.
- Identify all denial trends and provide education of steps to prevent future avoidable denials.
- Initiate/manage all insurance appeals in a timely manner.
- Communicate all denial trends and denial increases to direct supervisor/manager in order to positively affect the volume of denials.
- Organize the workflow to ensure that denials are worked according to departmental policy and standards.
- Manage correspondences and any ADR requests as defined within department workflow procedure to ensure timeless and accuracy of response.
- Complete special projects as assigned by Supervisor/Manager.
- Processing of all refunds or credit reversals in a timely manner as defined within the departmental credit/refund policy/procedures.
- Responsible for all government monthly credit reporting preparation and requirements
- Responsible to handle all denials related to charge capture for improved integrity of charge capture.
- Responsible to accurately update patient demographics, insurance registration information, verification of insurance, etc.
- Responsible for the consolidation of duplicate guarantor/patient accounts within the AR management system in an accurate/timely manner.
- Responsible to research and complete a detailed analysis of all payer variances based on our Contract modeling within our AR system.
- Must have the skill set and understanding of payer and government payer contracts/schedules in order to confirm expected reimbursement amounts are correct.
- Work closely with other departments on revenue integrity issues including variance contract build issues, charging issues, A/R type issues and other items as define.
- Responsible for electronic remittance, eligibility and claims agreements to insure the proper processing of electronic transactions, electronic remittance requirements and other payer requirements for billing.
- Responsible for the processing of all vendor claim updates, returns and resubmissions for payment.
- Other duties as assigned.
- Exhibit good professional communication and customer service skills at all times while working with coworkers and employees in multiple departments within the system.
Additional Information
Spartanburg Regional Healthcare System (SRHS) offers a full spectrum of services through six hospital campuses: Spartanburg Medical Center, Spartanburg Medical Center — Mary Black Campus, Pelham Medical Center, Cherokee Medical Center, Spartanburg Hospital for Restorative Care and Union Medical Center. SRHS also includes Ellen Sagar Nursing Center and Woodruff Manor. SRHS provides unparalleled cancer care through Gibbs Cancer Center & Research Institute, with locations in Spartanburg, Greer, Union and Gaffney. The multidisciplinary Medical Group of the Carolinas has more than 600 physicians across Upstate South Carolina and western North Carolina. SRHS employs more than 9,000 associates and offers outpatient surgery centers and a Level I Trauma Center.
Founded on Aug. 29, 1921, as Spartanburg General Hospital, Spartanburg Regional celebrates over 100 years of excellence.
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