AR SPECIALIST I

The Accounts Receivable Specialist I at Riverside Healthcare is responsible for maintaining accounts receivable related to insurance, managed care, third-party, worker's compensation, and other miscellaneous payers. This role also involves assisting with financial clearance of patients prior to service, providing financial counseling, and maintaining effective communication with insurance providers and demonstrates flexibility with assignments within professional scope/duties/licensure. The AR Specialist I will ensure accurate billing and follow up on any claim rejections to ensure timely payments.

Essential Duties

• Maintain accounts receivable for insurance, managed care, third-party, worker's compensation, and miscellaneous payers.
• Provide accurate and timely billing of all electronic and paper claims, including those to Blue Cross or miscellaneous accounts receivable.
• Review and bill secondary and tertiary insurances, ensuring correct charges, bill forms, and supporting documentation (EOBs).
• Assist patients with insurance issues and provide financial counseling as needed.
• Assist with creating and maintaining financial counseling policies, procedures, and training manuals.
• Maintain patient demographic information and update records as necessary.
• Handle telephone, internet, worklists, queues, ATBs, and appropriate letters to maintain Blue Cross and miscellaneous A/R.
• File and re-file claims to insurance companies; work on claim rejections to ensure timely rebilling.
• Understand and adhere to billing requirements for Medicare, Medicaid, HMO, PPO, and miscellaneous billing as defined by contracts, state, or federal laws.
• Utilize available resources to assist with various types of telephone inquiries, including charge problems, patient complaints, and diagnosis changes.
• Maintain daily billing audit reports, billing worklists, billing queues, and charge corrections.
• Participate in managed care in-services, onsite meetings, and conference calls with insurance provider representatives.

Non-essential Duties

• Assist with financial clearance of patients prior to services.
• Attend and actively participate in team meetings and training sessions.

Preferred Experience

• Two years of hospital patient accounting experience preferred.
• Previous collections or insurance experience within the last 3 years preferred.
• Knowledge of ICD9/CPT and medical terminology preferred.
• Proficiency in PC use and keyboarding skills.
• Excellent guest relation skills, including both verbal and written communication.
• Ability to work independently and handle multiple tasks.

Preferred Education

• Strong analytical skills for reviewing and processing insurance claims.
• Ability to handle patient inquiries and complaints effectively.
• Excellent organizational skills for managing billing queues, worklists, and patient records.
• Knowledge of Medicare, Medicaid, HMO, PPO, and other insurance billing requirements.

Employee Health Requirements

Exposure/Sensory Requirements:

Exposure to: 

Chemicals: None 

• Video Display Terminals: Extreme 
• Blood and Body Fluids: None 
• TB or Airborne Pathogens: None. 

Sensory requirements (speech, vision, smell, hearing, touch): 

• Speech: Needed for presentations/training, telephone communication, facilitate meetings. 
• Vision: Needed to read memos and literature. 
• Smell: N/A 
• Hearing: Needed for telephone communications, meetings, and listening to employee concerns. 
• Touch: Need to write, do computer entry, filing. 

Activity/Lifting Requirements 

Percentage of time during the normal workday the employee is required to: 

• Sit: 85% 
• Twist: 0% 
• Stand: 5% 
• Crawl: 0% 
• Walk: 5% 
• Kneel: 0% 
• Lift: 2% 
• Drive: 0% 
• Squat: 1% 
• Climb: 0% 
• Bend: 1% 
• Reach above shoulders: 1% 

The weight required to be lifted each normal workday according to the continuum described below: 

• Up to 10 lbs: Occasionally 
• Up to 20 lbs: Occasionally 
• Up to 35 lbs: Not Required 
• Up to 50 lbs: Not Required 
• Up to 75 lbs: Not Required 
• Up to 100 lbs: Not Required 
• Over 100 lbs: Not Required 

Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.): Lifting is not usually required. 

Maximum consecutive time (minutes) during the normal workday for each activity: 

• Sit: 408 
• Twist: 0 
• Stand: 24 
• Crawl: 0 
• Walk: 24 
• Kneel:0 
• Lift: 9 
• Drive: 0 
• Squat: 8 
• Climb: 0 
• Bend: 8 
• Reach above shoulders: 4 

Repetitive use of hands (Frequency indicated): 

• Simple grasp up to 10 lbs. Normal weight: 5- 10# frequent 
• Pushing & pulling Normal weight: 
• Fine Manipulation: Terminal entry, calculator. 

Repetitive use of foot or feet in operating machine control: None 

Environmental Factors &Special Hazards 

• Environmental Factors (Time Spent): 
• Inside hours: 40 
• Outside hours : 0 
• Temperature: Normal Range
• Lighting: Average 
• Noise levels: Average 
• Humidity: Normal Range 
• Atmosphere: Dust &Poor Ventilation 

Special Hazards: None 

Protective Clothing Required: None