Position Overview: We are seeking a detail-oriented and experienced Out of Network Accounts Receivable (A/R) Representative to join our healthcare finance team. The ideal candidate will be responsible for managing and resolving out-of-network insurance claims and ensuring timely and accurate reimbursement. This role requires a strong understanding of medical billing, coding, and insurance procedures, along with excellent analytical and communication skills.

Key Responsibilities:

• Claims Management:

  • Review, submit, and follow up on out-of-network insurance claims to ensure timely payment.
  • Investigate and resolve claim denials and discrepancies by working with insurance companies, patients, and internal departments.
  • Appeal denied or underpaid claims by providing necessary documentation and evidence.

• Account Reconciliation:

  • Reconcile payments and adjustments, ensuring accuracy in patient accounts and financial records.
  • Monitor accounts receivable aging reports and take proactive measures to collect outstanding balances.
  • Perform audits on patient accounts to identify and rectify errors.

• Communication:

  • Communicate with insurance companies to verify coverage, obtain authorizations, and clarify payment policies.
  • Serve as a point of contact for patients regarding billing inquiries, providing clear and accurate information.
  • Collaborate with internal departments, including billing, coding, and patient services, to streamline processes and improve reimbursement rates.

• Documentation and Reporting:

  • Maintain accurate and detailed records of all claims, payments, and communications with insurance companies.
  • Generate regular reports on account statuses, collection activities, and financial performance metrics.
  • Ensure compliance with federal, state, and payer-specific billing regulations and guidelines.

Qualifications:

• High school diploma or equivalent; associate's degree in healthcare administration, finance, or related field preferred.
• Minimum of 2 years of experience in medical billing and accounts receivable, specifically with out-of-network claims.
• Strong knowledge of medical terminology, billing codes (CPT, ICD-10), and insurance procedures.
• Proficiency in using billing software and electronic health records (EHR) systems.
• Excellent analytical, problem-solving, and organizational skills.
• Strong verbal and written communication skills.
• Ability to work independently and as part of a team in a fast-paced environment.