The Accounts Receivable Specialist follows up with insurance carriers on denied, underpaid, or unresolved insurance claims. This position requires a comprehensive understanding of the entire revenue cycle and the appropriate actions to take to resolve claim issues with payers in a timely manner. Employees should strive to maximize their performance and contribution to the organization and the clients served every day. Employees are expected to work in a manner that demonstrates a commitment to quality, patient safety, employee engagement, innovation, and the highest standards of personal integrity, professionalism, and competence.

This position is an advocate for the overall culture, vision, and values of the organization. The position reports to the Manager of the CBO.

THIS POSITION IS IDEAL FOR SOMEONE WHO IS:

• Autonomous/Independent - Ability to work efficiently and acquire knowledge necessary for positive outcomes with little assistance.
• Dependable - More reliable than spontaneous.
• Advocacy - Thrives on being an advocate for our client(s) by bringing continuous improvement to our team for operational, clinical, and financial process improvements and driving the resolution of issues.
• People-oriented - Enjoys interacting and collaborating with diverse positions internally and externally by bringing together all perspectives to arrive at the best solution.
• Customer Service Success Driven - Possesses the ability to build consultative client relationships, excels at working with internal cross-functional partners, and thrives in a dynamic, team-focused environment delivering against tight deadlines.

PRIMARY RESPONSIBILITIES INCLUDE BUT ARE NOT LIMITED TO:

• Follows organization policies and procedures.
• Provides superior customer support to our clients and their customers by responding to questions and requests; effectively escalates issues as required.
• Cross-trained to provide department coverage.
• Effectively trains team members.
• Successfully navigates multiple vendors including, but not limited to, payer websites and clearinghouses.
• Produces and maintains department policies, procedures, documentation, and training materials for role-specific activities.
• Upholds "best practices" in day-to-day processes and workflow standardization to drive maximum efficiencies across the team.
• Maintains professional and consistent communication with the team and clients to ensure that all needed items are received in a timely manner.
• Routinely collaborates with department managers to correct problems and improve services.

PRIMARY DUTIES INCLUDE:

• Accurately documents collection activity performed.
• Identifies inaccurate claim denials, under or over payments, billing errors, and discrepancies to correct and ensure resolution.
• Informs manager of identified issues or trends.
• Manages inbound and outbound calls for multiple clients, including handling different topics and acting as a contact between patients and clients.
• Provides timely resolution of assigned accounts for multiple clients.
• Successfully submits appeals to insurance companies to obtain reimbursement.
• Successfully navigates multiple vendors, including, but not limited to, payer websites and clearinghouses.
• Meets specified department performance requirements.
• Resolves support tickets submitted by clients and assigned to the department according to metrics.
• Manages time and multi-tasks appropriately to meet expectations of management and peers.
• Remote employees are responsible for sufficient internet connectivity and equipment necessary to complete assigned job duties efficiently.
• Remote employees are responsible for maintaining a quiet and organized work area during scheduled working hours.
• Other responsibilities as assigned.
• Minimum travel may be required.

MINIMUM QUALIFICATIONS, SKILLS, AND ABILITIES:

• High School Diploma or equivalency required.
• Prior EPIC and/or healthcare experience preferred.
• 2+ years' experience in healthcare (professional) billing, health insurance, or equivalent operations work environment.
• Adhere to all HIPAA guidelines.
• Excellent communication and problem-solving skills.
• Ability to read and understand an EOB.
• Ability to manage multiple tasks/projects simultaneously and adapt to frequent priority changes.
• Ability to work both collaboratively and independently.
• Capacity to identify and implement improvement opportunities where enhanced processes, technology, or efficiencies can be applied.
• Proficient technical skills and customer satisfaction skills, including the ability to troubleshoot products, use MS Office applications, and webinar software.

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.