Accounts Receivable Specialist II

Description

POSITION SUMMARY

The NCMS Accounts Receivable Specialist II is responsible for processing insurance claims and billing. They will work within the scope of responsibilities as dictated below with guidance and support from AR & Billing leadership teams.

ESSENTIAL FUNCTIONS

• Processes claims: investigates insurance claims; properly resolves by follow-up & disposition.
• Verifies patient eligibility with secondary insurance company when necessary.
• Bills supplemental insurances including all Medicaid states on paper and online.
• Mails all paper claims.
• Manages billing queue as assigned in the appropriate system. Investigates and updates the system with all information received from secondary insurance companies.
• Ensures that all information given by representatives is accurate by cross referencing with the patient's account, followed by using honest judgement in any changes that may need to be made.
• Processes denials & rejections for re-submission (billing) in accordance with company policy, regulations, or third party policy.
• Updates patient files for insurance information, Medicare status, and other changes as necessary or required.
• Keeps email inbox requests up to date; checks for new messages on an hourly basis.
• Complies with HIPAA rules, appropriately safeguarding PHI or other private & confidential information.
• Maintains accurate and detailed notes in the company system.
• Adapts quickly to frequent process changes and improvements.
• Is reliable, engaged, and provides feedback to improve processes and policies.
• Attends all department, team, and weekly company meetings as required.
• Appropriately routes incoming calls when necessary.
• Meets company quality standards.
• Embraces and exemplifies ADS core values:
• We put our people first.
• We serve our members with passion.
• We take ownership.
• We pursue excellence.
• We never stop growing.

OTHER RESPONSIBILITIES

• May perform any additional responsibilities or special projects as required.
• Duties and responsibilities may be subject to change based upon the needs of the department.
• May provide cross-functional support as business needs demand.

Requirements

MINIMUM REQUIREMENTS

• High School diploma or equivalent
• 1 year experience with insurance billing and processing claims
• 1 year experience with Medicare claims, and Medicare and private insurance verification
• Knowledge of insurance portals; familiarity with a variety of medical and/or insurance terms or practices
• Knowledge of, or ability to learn all areas of collections specialization
• Proficiency in basic math and business calculations
• Working knowledge of computer/data entry with the ability to learn new systems
• Basic level of MS Office proficiency

EXPECTED COMPETENCIES

• Friendly, professional, and effective communications skills; able to calmly present solutions in challenging situations.
• Proactive identification of challenges, and solution-oriented approach to problem solving.
• Service-orientation and aptitude to aptitude to resolve insurance and/or patient matters.
• Effective analytical skills: able to use inductive and deductive reasoning to anticipate outcomes.
• Self-directed accountability and reliability
• Effective communication, and interpersonal skills, with the ability to influence and collaborate effectively with cross-functional teams.
• Able to manage and prioritize multiple tasks/projects, work autonomously, and meet deadlines.
• Able to work well in a team environment that promotes inclusiveness and communication among team members.
• Communication using both verbal and written English proficiency.
• Cultural competence
• Cross-trained on all collections processes

PHYSICAL DEMANDS

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 employees with disabilities to perform the essential functions.

While performing the responsibilities of the job, the employee is required to remain in a stationary position most of the time (stand or sit). While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel; and talk or hear. The employee is frequently required to stand, walk, and reach with hands and arms. The employee is occasionally required to stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by this job i