AR Recovery Specialist

• Analyze insurance reimbursement receipts.
• Perform follow-up actions with insurance companies to ensure timely and full payment.
• Ability to recognize correct denials and make the appropriate adjustment in PM system as needed.
• Ability to recognize correct recoupments and make the appropriate adjustment in PM system as needed.
• Ability to recognize incorrect recoupments and appeal the decision per correct carrier guidelines.
• Utilize account information to assist in write-offs for inclusive CPTs by payor.
• Update job knowledge by participating in educational opportunities.
• Serve and protect sensitive information by adhering to professional standards, company policies and procedures, federal, state, and local requirements and standards.
• Learn, maintain and apply multiple recovery methodologies respective to carrier specific medical policies, denials and appeal processes.
• Trend, classify, resolve and communicate issues in the AR to optimize your individual productivity but to also resolve front end issues that improve the health of the account(s) you are assigned.
• Manage both quality and quantity on a consistent basis, continually seeking to outperform yourself and grow your professional knowledge in the process.
• Ability to identify and appropriately escalate issues on any patient account being reviewed and resolve the concerns properly and efficiently
• Ability to multitask, moving from primary to secondary tasks while maintaining target and deadline driven goals.
• Ability to utilize multiple resources in identifying denials and the appropriate approach in seeking resolution and reimbursement including but not limited to: Medical policy bulletins, LCD's, NLCD's, CCI edits, Carrier Sites, Remittance/Remark codes, EOBs, Correspondence, AASO GSD, account alerts.

Skills & Qualifications:

• Orthopedic AR Experience preferred

• At least 2 years of medical billing experience.
• At least 2 years of previous experience in an AR Recovery driven role.
• Knowledge of Practice Management and Electronic Medical Record systems such as Centricity, Phoenix Ortho, NextGen, E-ClinicalWorks, Allscripts, Athena - preferred.
• Understanding of Anatomy and medical terminology.
• Understanding of CPT codes, HCPCs codes, ICD-10 codes.
• Understanding of ERA EOB remittances and insurance carrier coordination of benefits and processing - preferred.
• Working knowledge of programs such as, Outlook, Excel, and Word etc.
• Working Knowledge of: Medical policy bulletins, LCD's, NLCD's, CCI edits, Carrier Sites, Remittance/Remark codes, EOBs, Correspondence, AASO GSD, account alerts.

• High school diploma or equivalent