AR Specialist

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POST DATE 8/13/2016
END DATE 11/5/2016

Adreima Raleigh, NC

Raleigh, NC
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #


JOB SUMMARY: This position is responsible for Billing, Re-Billing, Post-payment and Account follow-up and/or grievance preparation of assigned Client Hospital Accounts Receivable or with Skilled Nursing Facilities. Working at a centralized location, responsibilities may include account maintenance of specialized or multiple payers including state and federal government programs, managed care, commercial and other insurance groups. The Patient Account Specialist may serve as a liaison to clinical auditors, other team members, hospital staff, government agencies and health plans to facilitate the appropriate and prompt payment of claims. This individual must demonstrate a commitment to the organization's strategic plans, short and long term goals and mission, vision and values by representing the company in a caring and professional manner.

Primary / Essential Functions:

The Primary/ essential job duties may not be exhaustive.

Effectively and efficiently performs essential job duties.


* Reviews and/or scrubs final billed initial claims for accuracy and completeness before submitting for payment

* Obtains necessary patient records required as attachments to claims

* Calculates Tier, Outlier, DRG and/or other Fee Schedule based reimbursement

* Submits electronic and/or hardcopy claims with any attachments as per the contract timely filing criteria

* Documents all account activity in the hospital system notes and the database


* Within appropriate time frames, contacts the health plan by phone or website to determine status of claim

* Documents all follow-up actions in the hospital account notes and database and sets up account for additional review based on client expectations for follow-up of unresolved accounts


* Researches all account information on paid or partially paid claims and analyzes the status of the payment related to the expected payment calculation and itemization provided by the remittance advice

* Determines if payment is appropriate according to contract specifications

* Analyzes any denied, disallowed or non-covered claims and determines if non-payment is based on medical or technical reasons

* Resolves any technical issues when warranted with health plans via phone or website

* Prepares requests for account balance adjustments in accordance with client specific procedures

* Prepares claims for clinical audit processing in the case of authorization, coding, level of care and/or length of stay denials

* Processes overpayment transactions in accordance with client specific procedures

* Follows guidelines for prioritization, timely filing deadlines, hospital and database documentation

Minimum Qualifications:

* Knowledge and skills typically acquired through receipt of a diploma

* Requires a minimum of five years of related job experience

* Prior experience with billing for SNF/ Rehab/ Therapies preferred but not required

* Experience in the health care field or with a health care services related business

* Working knowledge of computer programs and technical applications

* Excellent verbal and written communication skills are essential

* Strong organizational and coordination abilities are required

Accounts Receivable Specialist, Hospital Biller, Healthcare Finance, Medical Reimbursement Specialist