Billing and AR Specialist/Full time/Wallingford

Gaylord Specialty Healthcare is a health system dedicated exclusively to medical rehabilitation. We provide inpatient and outpatient care for people at every point in their journey from illness or injury to the most advanced state of recovery they can achieve. Our Mission: To enhance health, maximize function, and transform lives. Our values: Integrity, Compassion, Accountability, Respect and Excellence. These values guide us in providing quality patient care and transforming the lives of our patients. 

Job Summary:   The Accounts Receivable Specialist plays a vital role in the hospital’s revenue cycle by managing the full spectrum of billing processes, payment collections, insurance reimbursement, and denial resolution. This position requires a strong understanding of healthcare billing practices, payer requirements, and revenue cycle workflows. The specialist works collaboratively with internal teams to ensure claims are billed correctly, denials are efficiently resolved, and revenue is collected in a timely manner. By supporting process improvement, communication across departments, and patient billing clarity, this role helps ensure the financial health of the organization and a smooth experience for patients.

Essential Duties and Responsibilities: include the following. Other duties may be assigned.

• Financial Integrity

·         Ensure claims are accurately submitted to insurance payers, ensuring compliance with payer-specific requirements.

·         Monitor outstanding claims to identify payment issues.  Takes appropriate actions to ensure timely resolution and accurate reimbursement from third-party             payers or patients.

·         Analyze denials and underpayments, initiating appeals or corrected claims when necessary.

·         Track A/R aging, denial trends, and reimbursement effectiveness, reporting issues to leadership as needed.

• Patient Experience

·         Ensure accurate billing and timely resolution of issues to maximize the patient experience.

·         Assist with complex patient inquiries related to insurance billing and claim status.

·         Support processes that improve the overall patient financial experience.

• Revenue Cycle Advancement

·         Evaluate workflows and denial trends to identify areas for operational improvement.

·         Recommend changes to billing/collection practices or systems that enhance claim acceptance and reduce rework.

·         Assist with testing and updates to software and payer portals.

·         Perform root cause analysis to increase the clean claim rate and reduce first pass denials.

·         Contribute to departmental goals, KPIs, and strategic initiatives to improve revenue cycle performance. 

• Collaboration and Communication

·         Coordinate with all revenue cycle teams to resolve claim issues and prevent billing errors and denials.

·         Communicate with payers to ensure appropriate payment.

·         Maintain positive working relationships with internal departments, third-party payers, and patients.

·         Participate in team meetings and contribute to a culture of continuous improvement and accountability.

•  Exhibits IT IS ICARE values:

·         Innovation: Embracing creativity and new ideas to improve processes and outcomes.

·         Teamwork: Collaborating effectively with others to achieve shared goals and objectives.

·         Inclusion: Fostering an environment where everyone feels valued and supported.

·         Safety: Prioritizing the well-being and security of patients, individuals and communities.

·         Integrity: Acting with honesty and transparency in all interactions and decisions.

·         Compassion: Showing empathy and kindness towards others, especially in challenging situations.

·         Accountability: Taking responsibili