AR SPECIALIST II

The Accounts Receivable Specialist II 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 actively supports patient financial clearance prior to service and assists in developing and maintaining financial counseling policies, procedures, and training manuals and demonstrates flexibility with assignments within professional scope/duties/licensure. The AR Specialist II also plays a key role in pursuing payments, providing financial counseling, and supporting customer service functions.

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 downloading, editing, and transmitting claims.
• Review and bill secondary and tertiary insurances, ensuring accuracy in charges, bill forms, and supporting documentation (EOBs).
• Actively pursue payment from patients at the time of service.
• Assist patients with insurance issues and provide financial counseling, including monitoring and arranging payment plans, identifying charity cases, and determining bad debt accounts.
• Assist in creating and maintaining financial counseling policies, procedures, and training manuals.
• Attend managed care in-services, onsite meetings, and conference calls with insurance provider representatives.
• Maintain daily billing audit reports, billing worklists, billing queues, and charge corrections.
• Maintain patient demographic information and utilize telephone, internet, worklists, queues, ATBs, and letters to manage all insurance, managed care, third-party, worker's compensation, and miscellaneous accounts receivable.
• File and re-file claims to insurance companies and correct any rejected claims to ensure timely rebilling.
• Responsible for answering overflow incoming customer service phone lines.
• Perform and monitor financial assistance in the outpatient mental health setting.
• Timely and accurately review the Reconciliation Manager to ensure all claims are accepted by the payer.
• Understand billing requirements for Medicare, Medicaid, HMO, PPO, and miscellaneous billing as defined by contracts, state, or federal laws.
• Utilize resources to handle various types of telephone inquiries, such as charge problems, patient complaints, and diagnosis changes.
• Perform other duties as assigned.

Non-essential Duties

• Assist with financial clearance of patients prior to services.
• Act as a subject matter expert for the team and help with training new staff members as needed.

Preferred Experience

• Previous billing, 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 verbal and written communication.
• Ability to work independently and manage multiple tasks effectively.

Required Licensure/Education

• High school graduate or equivalent required.
• Minimum of two years of hospital patient accounting experience required.
• Two years (minimum) of achieving \"Consistently Exceeds\" evaluations in job performance.

Preferred Education

• Strong analytical and organizational skills for managing complex billing and collection tasks.
• Effective communication and customer service skills to handle patient inquiries and resolve billing issues.
• Ability to act as a financial counselor and support patients with insurance problems.
• Knowledge of state and federal regulations regarding billing and collections.

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