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AR Insurance Specialist
at Terros Health
- Job ID
- # of Openings
- Billing & Reimbursements
- Billing & Collections
- Weekly Hours
Terros Health is pleased to share an exciting and exciting opportunity for an AR Insurance Specialist, working as part of a high performing revenue cycle team. This individual will need to be professional, friendly, a self-starter, organized, and compassionate.
Terros Health is a healthcare organization of caring people, guided by our core values of integrity, compassion and empowerment. For more than four decades, the heart of everything we do is inspiring change for life. We help people manage addiction and mental illness, provide primary medical care, restore families, support our veterans, and connect individuals to the care they need.
If you are interested in working for one of the State's Leading Healthcare Organizations that promotes Integrity, Compassion, and Empowerment, we encourage you to apply!
The AR Insurance Specialist will be responsible for review and resolution of outstanding insurance balances on Commercial, Medicare and Medicaid accounts. The AR Insurance Specialist will be required to have keen analytical skills to evaluate appropriate next steps to bring aged account receivables to resolution. The Insurance Specialist will be responsible to ensure cash recovery goals are met and assigned receivables are appropriately addressed according to company, client and federal guidelines
- Effectively manages assigned insurance receivables to achieve company set expectations.
- Exceed productivity standards, as outlined by business line.
- Exceeds the department standard in work quality scoring and accuracy on all accounts worked.
- Completes timely follow-up on assigned accounts to ensure no cash loss.
- Exceeds monthly cash expectations as set out for assigned client receivables.
- Ensures insurance accounts are resolved within 90 days of placement.
- Demonstrates the ability to prioritize work with minimal oversight to meet outlined goals.
- Acts as a knowledge resource for team members.
- Perform account research.
- High level understanding of payer system functions.
- Clearly documents actions taken and next steps for account resolution in Enterprise Practice Management (EPM) system.
- Demonstrates advanced understanding of commercial, Medicare and Medicaid payers.
- Has knowledge of Commercial, Medicare and Medicare guidelines and is able to accurately perform corrections according to those guidelines.
- Demonstrates advanced understanding of claim needs and ability to accurately perform needed billing activities (Evaluation/Correction of billing edits, claim transmission, rejections, and other claim functions).
- Compiles appeals and approves appeal requests for team related to technical payment denials.
- Demonstrates the ability to act as request approver for team members to ensure accurate actions are taken for account resolution.
- Reflects understanding of payer contract verbiage and the ability to negotiate payment utilizing contract terms.
- Ensure strong communication skills to convey intricate account information.
- Maintain high quality account handling per client standards.
- Work within federal, state regulations, department/division and all Compliance Policies.
- Maintain clear, concise and accurate documentation of all attempts and/or contacts made and received for accounts in accordance with company and client specifications
- Maintain continuing education, training in industry career development.
- Maintain current knowledge of and comply with all federal and state rules and regulations governing phone calls and collections including HIPAA, FDCPA, Privacy Act, FCRA, etc.
- Attend training sessions as directed by management.
- Integrate information obtained through training sessions and policy changes immediately into daily routine.
- Develop professional relationships with internal and external customers, maintain open lines of communication and build rapport by providing timely and professional service.
- Assists Director in compiling data for Payer claims projects.
- Works closely with Credentialing Department to troubleshoot payer set up issues which have resulted in unpaid, denied or short pay claims.
- Process adjustments and/or write offs when appropriate.
- Monitors, processes and completes follow-up on credit balances; when necessary submits refund requests to management with supporting documentation.
- Contribute ideas for process improvement and special projects as assigned.
Terros Health offers an excellent benefit package including, but not limited to:
- Medical, dental, and vision insurance
- Group life and disability insurance
- Employer matched 401(k)
- Generous PTO/paid sick leave (4+ weeks in year 1)
- Wellness and employee assistance plan
- High School Diploma required, prefer an Associate degree in administration or equivalent experience in billing, finance or business administration and at least 2yrs experience.
- Experience in specific area of work applied for such as healthcare services, customer service and medical records.
- Worked in a production-based environment before and is a custom to being held to a high standard of productivity
- Above average skills in Excel and Word. Ability to creates and use Pivot Tables and V-Lookup Functions.
- Functional knowledge of CMS/HRSA/AHCCCS guidelines.
- Must have valid Arizona driver’s license, be 21 years of age with minimum 3 years driving experience and meet requirements of Terros Health’s driving policy.
- Must have a valid Arizona Fingerprint Clearance card or apply for an Arizona fingerprint clearance card (Level 1) within 7 working days of assuming role.
- Must pass a TB Test.
Physical demands of this position 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 the essential functions.