Accounts Receivable Specialist
Steward Health Care System LLC ("Steward") is a fully integrated, physician-led national health care services organization committed to providing the highest quality of care in the most cost-efficient manner in the communities where our patients live. Steward - the largest privately held health care company in the U.S. - owns and operates 35 community hospitals across nine states, serves over 1,000 distinct communities and employs approximately 40,000 health care professionals. In addition to our hospitals, the Steward provider network includes 4,800 providers, 25 urgent care centers, 87 preferred skilled nursing facilities, substantial behavioral health offerings, over 7,300 hospital beds under management, and approximately 1.5 million full risk covered lives through the company's managed care and health insurance services.
Steward Medical Group (SMG), Inc. is Steward's multi-specialty group practice with over 4,500 employees including over 1,800 physicians and advanced practitioners. SMG operates approximately 450 practice locations throughout Massachusetts, Southern New Hampshire, Rhode Island, Pennsylvania, Ohio, Florida, Utah, Arizona, Texas, Louisiana and Arkansas, and provides more than 4 million patient encounters per year.
Under the direction of the Supervisor, Accounts Receivable, the Accounts Receivable Specialist is responsible for resolution of patient account balances associated with insurance denials, answer incoming insurance and practice calls with the ability to explain charges, services and insurance billing questions. Work with practices and payers to resolve claim denials and comply with insurance and all relevant procedures, guidelines, and policies.
• Responsible for various aspects of medical billing: claim creation, claim submission, payment posting for insurance, and patient balances. These denials and appeals are billed in the AthenaNet system electronically.
• Reviews, interprets and applies contractual terms and identifies and/or applies contractual and administrative adjustments.
• Monitor insurance denials by running reports and contacting insurance companies to resolve and recover denied claims.
• Monitors aging reports for timely follow-up on unpaid claims.
• Performs retroactive review of registration data to aid in the assurance of clean claim submittal.
• Accurately documents claim actions taken within patient account/claims.
• Serves as a resource for problem solving issues related to registration, demographic, and insurance errors.
• Works collaboratively with Coding, Provider Enrollment, and Cash Posting team as well as coworkers, Team Leads, Managers, and practice staff to resolve claim and account issues.
• Assists Patient Accounts Team as needed with incoming and outgoing patient calls to resolve and collect on a patient statement.
REQUIRED KNOWLEDGE & SKILLS:
• Strong knowledge on third party payers guidelines and procedures required.
• Experience and/or knowledge of insurance denials process.
• Health care claims processing and follow-up background.
• Billing experience and insurance knowledge (eligibility, registration, etc.)
• Prior experience with AthenaNet billing system is strongly preferred.
• Customer / Patient Account Services Skills.
• Drives results while balancing multiple priorities and tasks.
• Strong verbal and written communication skills.
• Possess strong analytical skills and computer skills including Outlook, Excel, and Word.
I. Education: High School Diploma or equivalent required
II. Experience: 1-2 years of related experience required.
III. Certification: Certified Biller preferred.