ACCOUNTS RECEIVABLE SPECIALIST- Full Time

Job Description

Responsibilities

Come and join the RMC Family!

We have been in the community since 5. Our mission is to provide comprehensive multi-specialty medical services in the greater Riverside region. Your passion, inspiration, and talents are invaluable to us and our mission to serve others. Our facility can provide a place for you to thrive and continue your professional development. Quality Healthcare is our passion, improving lives is our reward. We are working to change lives and transform the delivery of healthcare. Riverside Medical Clinic is the best place to work, practice medicine, and receive care.

SUMMARY : Responsible for the accurate and timely processing of fee-for-service claims and account collections.

QUALIFICATIONS : To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Qualifications

EDUCATION and / or EXPERIENCE : High school diploma or general education degree required. Knowledge of medical terminology required. Two years prior experience in medical billing / collections is REQUIRED.

CERTIFICATES, LICENSES, AND REGISTRATIONS : None.

ESSENTIAL FUNCTIONS :

Essential functions are those tasks, duties and responsibilities that comprise the means of accomplishing the job’s purpose and objectives. Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. Note : Other duties may be assigned, deleted or changed at any time, at the discretion of management, formally, or informally, either verbally or in writing.

1. Assist the supervisor as requested.

2. Review, adjust, and / or mail out all assigned tracer claims

3. Initiate claim review and / or appeals, as indicated on assigned explanation of benefits.

4. Review, adjust, and / or process all assigned correspondence.

5. Work aging AR :

a. Contact insurance carrier to check on claim status and / or responsible party to settle account.

b. Review Explanation of Medical Benefits to verify accuracy of reimbursement

c. Verify insurance coverage

d. Initiate necessary account adjustments, change of charges and / or refunds as indicated.

6. Analyze and investigate denied claims to determine the root cause of denials, including coding errors, missing information, and billing discrepancies.

7. Prepare and submit appeals for denied claims, utilizing a comprehensive understanding of payer requirements and regulations to maximize the likelihood of successful resolution.

8. Resubmit corrected claims with the appropriate documentation and follow up to ensure timely processing.

9. Communicate with insurance companies, payers, and other relevant parties to resolve denials and obtain information needed for appeals and / or resubmission.

• Maintain regular follow-up with insurances and responsible parties to track the progress of appealed claims and pending actions. Escalate as necessary to achieve successful resolution.
• Stay informed about industry changes, billing regulations, and payer policies to ensure compliance with applicable laws and best practices.
• Manage and resolve claims with pending responses from insurance companies and / or other parties.
• Track and follow up on unpaid claims and / or incomplete documentation.
• Review account with no response and communicate with relevant parties to obtain necessary information
• Document all interactions and actions taken.
• Display a professional attitude through performance, appearance, and demeanor.

This opportunity offers the following :

Challenging and rewarding work environment

Growth and Development Opportunities within UHS and its Subsidiaries

Competitive Compensation

About Universal Health Services