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Job Summary:

Working under the daily supervision of Patient Business Services Management and under the general leadership of the Revenue Cycle Management Director, the PBS AR Specialist is responsible for following up on billed claims, reviewing denials, pursuing payments and ensuring all correspondence is accurately documented for account resolution. This position ensures that provision of excellent patient care is extended through the patient’s billing experience.

Major Duties and Responsibilities:

Conduct self in a professional manner that reflects the mission, vision, and values of EMSA.

Account resolution duties, to include contacting payers or identified responsible parties for claim status & resolution.

Monitoring and documentation of claim status, requesting necessary information, submitting appeals and accurate documentation of accounts.

Post denials and take appropriate actions to achieve account resolution, including submitting appeals.

Apply adjustments as needed based on correspondence received.

Review and research credit balances for account resolution.

Process correspondence related to patient accounts accurately.

Appropriately document patient accounts to reflect all updated and necessary information, including updated demographic or payer information.

Maintain set quality and quantity productivity standards.

Understands revenue cycle key performance indicators and works to achieve the KPIs of the team.

Maintain knowledge of current industry standards and organizational practices and work in a manner that supports a patient centered, team focused, and fiscally responsible organization.

Communicates with other team members and leaders on identified trends and process improvement opportunities.

Adhere to all organizational policies and work with the highest level of integrity.

Adhere to and enforce all safety standards and organizational policies.

Performs other duties as assigned.

Qualification Requirements:

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 of the job position.

Working knowledge of medical billing and medical terminology

Knowledge of Health Insurance Portability and Accountability Act (HIPAA)

Proficiency with Microsoft Office (Word, Outlook, Excel, and PowerPoint).

Excellent time management skills with attention to detail.

Ability to work independently and with a group and maintain good working relationships.

Education and/or Experience:

Minimum GED or High School Diploma

Minimum 2 years’ experience in a hospital or physician’s office working patient accounts or insurance workflows.

Essential Functions:

Physical Demands: This position requires a frequent amount of time at a stationary desk sitting for up to 8 hours daily with frequent repeating motions that may include wrists, hands, and fingers. Hearing and talking to interpret job functions are frequently required and frequent visual ability to judge distance and space and clarity up to 20 ft. There is minimal hand tool operation and minimal ascending or descending ladders, ramps, or stairs. Occasionally may need to lift pull or pull objects up to 25 lbs. in all directions with a maximum lifting of 50 lbs. there is occasional walking and standing but minimal kneeling, crouching, bending, twisting.

Working Conditions:

The position works in a temperature-controlled environment with occasional exposure to extreme temperatures to include humidity. Sometimes may be exposed to fumes, grease, or oil and may experience minimal poor ventilation or air circulation. The noise level is frequently quiet with minimal exposure to moving mechanical parts/machines.

Mental/Emotional:

This position is required to frequently meet deadlines, work with changing priorities, and assess the accuracy and completeness of work on a regular basis. Frequently use logic to analyze and problem solve difficult situations and communicate to express or exchange ideas using proper English grammar and spelling. Frequently utilize complex math and reasoning skills for budgeting, analysis, and risk assessment.