We wake up for women, every day. We're inspired by their strength, their stories and the choices they make in pursuing health for themselves and their families. Our vision is that every woman will have the care and knowledge she needs to lead a full and healthy life. Will you help us achieve it?
TheA/R Specialistwill be responsible for following up on pending and past due balances from insurance companies and patients in order to ensure that WHA receives proper reimbursement for medical services rendered.
*This is a 40 hr/week position, Monday - Friday at our Administrative office.
- Researches and corrects all denials received for designated alpha and discipline. Identifies trends in claim denials by insurance and efficiently solves the problem using available resources to ensure proper payment.
- Runs pending insurance reports and follows up on pending claims with insurance companies in a scheduled and timely manner.
- Sends insurance companies additional information for proper claims processing as necessary.
- Monitors turnaround time for explanation of benefits (EOB's) that require more information.
- Works proactively with insurance provider representatives, when possible.
- Writes appeal letters to insurance companies as needed. Utilizes the insurance websites or electronic appeal process when possible to expedite insurance turnaround time.
- Works with internal customers (such as remissions, patient services staff, coders, contract negotiators, etc.) to identify, monitor, and/or improve insurance-related issues.
- Identifies delinquent patient accounts and contacts patients with delinquent account by phone and/or letter in accordance with WHA policy.
- Audit patient's accounts that have pending claims with insurance companies.
- Assists patients (primarily via telephone) by answering questions about statements and resolving billing issues.
- Updates patient registration and insurance information as requested by patient. Identifies missing registration information and utilizes all resources including hospital databases and insurance websites. Resubmits claims electronically to updated insurance as needed.
- Evaluates patient financial status and establishes payment arrangements in accordance with WHA policy. Follows and reports status of delinquent payments.
- Prepares documentation of non-compliant delinquent patient accounts for clinician review in accordance with WHA policy. Refers accounts to outside collection agency if appropriate.
- Investigates returned mail from patients and insurances for current billing addresses. May perform limited skip trace before referring to outside collection agency in accordance with WHA policy.
- May audit credits on accounts. Prepares account with required documentation for Accounts Payable to process refund to insurance and/or patient.
- Compiles complete documentation for each adjustment to be filed in batch, such as EOB's, encounter forms, account inquiry, etc.
- Documents all correspondence and conversations with patients and insurance carriers into patient's account per established guidelines.
- Performs various collection actions including contacting patients by phone and resubmitting claims to insurance.
- Takes responsibility for and demonstrates safe work practices.
- Maintains regular and predictable attendance.
- Maintains WHA confidentiality standards.
- Attends WHA and office meetings.
- Models The Values Statement and The Patient Experience of WHA.
- High school diploma or GED required.
- Experience in medical billing and collections required, preferably in an OB/GYN clinic.
- Knowledge of medical terminology and coding, including ICD-9, CPT and HCPCS required.
- Demonstrated ability to effectively work with others.
- Knowledge of collection law and practices.
- Knowledge of local and major national medical insurance practices required.
- Research and problem-solving skills in order to resolve complex billing issues.
Women's Healthcare Associates, LLC is an equal opportunity employer.
Oregon employers are required by a number of state and federal agencies to display a variety of workplace notices and posters, including:
Federal Family and Medical Leave Act
Oregon Family Leave Act