Sr. Accounts Receivable Associate

SUMMARY: The Senior Associate, Accounts Payable position has an advanced level of responsibility for performing research, correction and updates within the accounts receivable management systems toward the purpose of billing for and receipt of compensation on services provided in the course of resident care across multiple lines of business and payers. Completion of account management functions such as billing, collection, reimbursement calculation, cash posting and reconciliation on assigned inventory are basic functions required for this position. Oversees the tracking of all claims in order to establish accurate collections of accounts and maintain them below DSO expectation defined in assigned area. Assists in the resolution of day-to-day issues/questions and is the first point of contact for the A/R Associates. This role is also expected to mentor team members.
Skills to perform these functions are expected from the employee to be present and maintained through internal and external ongoing education.
ESSENTIAL DUTIES AND RESPONSIBILITIES: include the following. Other duties may be assigned.
Each Senior Associate A/R will be focused on multiple areas listed below:
Admissions and Census review
Triple Check Claim Validation
Billing for all business lines
3rd Party Follow Up
Private Pay Follow Up
Cash and Denials posting
Credit Balance and Refund resolution
Resident Final Billing
Customer Service-A/R Help Desk
Month-end Close
Provides operational support to the A/R Supervisor and A/R Manager.
Responsible for the accurate pre-billing review, billing, follow up, and cash posting of charges within their assigned functional area across multiple payer types and lines of business.
Additional Responsibilities:
Translates internal charge files to appropriate billing formats for electronic and manual claims submission to third party and private payers.
Performs follow-up and collections of accounts with outstanding balances. Adheres to department guidance on account documentation note structure and content to provide all stakeholders with actions taken and next steps for accounts receivable management.
Initiates appeals, corrected claims submissions, or submits medical records in response to payer requests for information or denied claims.
Post contractual allowances, write-offs and payments against appropriate claim/line item using the Explanation of Benefits (EOB) or Remittance Advice.
Post rejection and denial transaction codes and descriptions using the Explanation of Benefits (EOB) or Remittance Advice.
Identifies and reports underpayments using payer contracts and other tools available for research.
Proactively works with payers and in-house resources to identify and resolve issues that hinder optimal and correct account payment.
Researches unapplied cash and credit balances utilizing appropriate payment and write-off codes.
Utilizes and applies the appropriate regulations in order to assure compliance in payment practices.
Resolves both internal and external customer issues within an appropriate time frame; shows persistence and seeks alternatives when obstacles arise.
Meet defined department goals and activity metrics.
Attend team, departmental and organization meetings.
Obtains continuing education as appropriate for updated regulations and revenue cycle trends and techniques.
Attends (2) continuing education association meetings throughout the calendar year.
Speak and write clearly, respectfully and effectively when relating information
Build effective relationships with stakeholders and provide them with timely communications and actions taken. Ensure next steps are taken for root cause resolution
Customer Service
Problem solve through both internal and external customer issues within an appropriate time frame; takes the initiative to obtain customer satisfaction results
Displays professionalism, tact, respect and team effort when working with co-workers, management and other internal/external customers.
Team Support
Perform ad-hoc training to A/R Associates.
Contribute to improve team aging results in partnership with other staff members.
Analysis of problem areas, identify and recommend process improvement.
Act as a subject matter resource for A/R Associates who may need a greater depth of knowledge to complete tasks
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Excellent customer service focus.
Strong problem solving, critical thinking and analytical skills
Must have effective organizational skills and a high attention to detail.
Ability to interact with staff at all levels.
Strong interpersonal skills.
Ability to multi-task, prioritize needs to meet required timelines.
Operates effectively within the organizational structure; demonstrates eagerness to learn and assume responsibility; displays a "can do" approach to work; shows flexibility in response to process change and adapts to and accommodates new methods and procedures; accepts direction and feedback from supervisor and follows through appropriately.
Knowledge of billing, collections, and cash posting processes in a health care provider environment
Medicare, Medicaid or Managed Care experience
Experience working with CPT and ICD-10
Knowledge of medical terminology.
Ability to multi-task, prioritize needs to meet required timelines
Knowledge of Federal, State and third party electronic claims submission, denials and reimbursement practices
Experience working with CMS1500 and UB04 claim forms
Knowledge of Vision or other medical practice management systems
Proficient knowledge of Microsoft Office including Excel, Word and Outlook
High School Diploma or equivalent is required.
Minimum five (5) years healthcare accounts receivable experience in billing, collections, cash posting or other healthcare revenue cycle related experience is required.
Graduation from an accredited two-year college is required (Major coursework is preferred in Accounting, Finance, Business Administration, Healthcare Finance/Administration) or a minimum of 7 years' experience in health care accounts receivable will be accepted in lieu of a degree
Current Certified Revenue Cycle Specialist (CRCS-I) from the American Association of Healthcare Administrative Management (AAHAM) is required.
Must be able to read, write and communicate in the English language.
Maintain current Certified Revenue Cycle Specialist (CRCS-I) certification from the American Association of Healthcare Administrative Management (AAHAM).

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