The Accounts Receivable Representative is responsible for following up and resolving claims that have been submitted to third party insurance payers. This includes claims that have yet to be adjudicated, underpaid or overpaid accounts, and denied accounts that require resolution. The Accounts Receivable Representative is accountable for meeting or exceeding daily/weekly/monthly productivity targets set forth by ECP productivity policy & procedure standards.
Essential Duties and Responsibilities: The following are general responsibilities associated with the job and are listed in order of greatest to least amount of time spent on the duties.
- Conducts appropriate follow-up of no response third-party receivables in accordance with payer guidelines
- Reviews and resolves claim denials, conducts follow-up, appeals processing, and associated template management when appropriate
- Develops and maintains a working knowledge of payer contractual requirements
- Establishes effective relationships with other Accounts Receivable Representatives and works in conjunction with all functional areas of the billing department
- Addresses/resolves issues relating to patient accounts while noting account actions for complete audit trail of follow-up activity
- Processes credit balances for assigned insurance(s) in accordance with payer and enterprise guidelines
- Meets productivity and quality measurement standards as set forth by ECP enterprise guidelines
- Addresses denial write-offs in accordance with the ECP OPH Adjustment Approval Policy
- Ability to type and enter data with proficiency and accuracy
- Proven ability to manage multiple projects at a time while paying strict attention to detail
- Ability to successfully meet demanding timelines
- Ability to operate essential office equipment, including multi-line phone, computer, fax machine, scanner and photocopy machine
- Ability to work overtime when applicable
- Displays eagerness to accept additional responsibilities at the discretion of management
- Makes decisions in an ethical/effective/sound manner, adheres to corporate compliance/risk management/safety standards, displays an open-minded attitude, establishes priorities, conceptualizes, and organizes time and resources to accomplish the job.
- Responsible for exercising regular and punctual attendance; complies with ECP policies regarding absenteeism and tardiness.
- Adheres to ECP confidentiality policy which includes verbal, written, computer generated, computer accessed, filmed and recorded information related to patients, their family and visitors, staff, physicians, and clients. Responsible for the protection of confidentiality of data at all times.
- Works in a safe manner and follows all ECP safety requirements. Reports all incidents, near misses, and adverse events.
Job may require other duties as assigned.
Preferred Qualifications: While not required, the following are preferred qualifications associated with the job and will be under consideration.
- Minimum 2 years billing or follow-up experience within a physician’s office or medical environment
- Experience in Optometry/Ophthalmology physician practice environment
- NextGen and Waystar software experience
Education and Experience: The minimum level of education and experience required to perform the job at a satisfactory level.
- High School diploma is required.
Knowledge, Skills, and Abilities: The minimum level of knowledge, skills, and abilities to perform the job at a satisfactory level.
- Demonstrates understanding of business and how actions contribute to company performance
- Demonstrates excellent customer service skills
- Knowledge of medical terminology, healthcare coding systems, and clinics functions
- Experience in the use of CPT and HCPCS required
- Utilizes Practice Management (PM) system and all other software systems in accordance with Billing Office and/or ECP protocols
- Reviews account information to identify trends, preventable root cause issues, and communicates these to the Insurance Billing Supervisor
- Uses creativity/innovation in carrying out responsibilities/introducing new ideas or programs; adapts traditional methodologies in accordance with a changing business environment.
Decision Making: Common decisions made in the job and the level of review or autonomy needed to finalize such decisions.
- HIPAA compliance is strictly followed in accordance with industry regulations
- May make recommendations regarding policies associated with the job’s purpose and essential responsibilities.
Work Environment: Environmental or atmospheric conditions commonly associated with the performance of the functions of this job.
- General office conditions.
Physical Requirements: Activities that are commonly associated with the performance of the functions of this job. The physical demands described below are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
- While performing the duties of this job, the employee is regularly required to stand and walk and sometimes sit; use hands to type, handle, or feel objects or controls; reach with hands and arms; and talk or hear.
- Regular attendance is a necessary and essential function.