Accounts Receivable Representative II at Orthopedic One – Westerville, Ohio

Position Summary: Responsible for the daily workflow and A/R of the assigned A/R provider specialty team. Responsible for the expedient collection of payments at the highest level of reimbursement allowed for the medical services provided for assigned physician, APP, and/or therapy providers.

Responsibilities/Accountabilities:

Claims:

1. Review outstanding claims and initiates follow up with insurance carriers regarding denials for specified providers, reviewing aged report monthly.
2. Ensure claims that remain unpaid are followed up on no later than 60 days past submission. Monitors A/R over 180 days to ensure KPIs are met. Monitor timely filing to ensure claims are worked timely.
3. Ensure receivable notes of action taken are accurate and present on each claim.
4. Assist in level 2 appeals and provider representative meetings with payers for claims that cannot be overturned.
5. Participate in the development of provider and staff education on payer policies and denial trends.
6. Develop communication plan for keeping patient accounts team members informed of changes to payer processes or protocols including development of new department workflows as needed.
7. Make recommendations to leadership regarding opportunities for process improvements including reporting.
8. In partnership with department leadership, develop and maintain effective staff training materials on current payer processes and procedures. Trains new staff and educate existing staff as needed.
9. Conduct workflow competency reviews with A/R team members.
10. Assist in planning and communicating A/R team member assignments including weekly huddles with team members.
11. Monitor claims unpaid and claims on hold to ensure the claims are paid in a timely manner.
12. Assist in reviewing refund and takeback requests with the reconciliation team.
13. Monitor data and KPI’s for team members to ensure that every claim is worked within 60 days of denial.
14. Maintain monthly adjustment log to ensure accounts are adjusted timely and follow leadership directives.

Reimbursement:

1. Professionally communicates with physicians and their staff regarding reimbursement problems when necessary.
2. Audits charges for optimal charge coding when needed. Communicates carrier claims denial patterns to Supervisor.
3. Keeps up on changes in medical billing and coding procedures. Follows insurance carrier guidelines. Communicates carrier updates to Supervisor.

Collections:

1. Follows department collection guidelines and procedures for outstanding patient and insurance balances related to assigned carriers and/or providers.

Denials:

1. Submits corrected claims and appeals to insurance carriers timely. Accessing carrier websites when applicable.
2. Responds to all types of correspondence within one week of receipt.
3. Accurately records account receivable note of actions taken on claims denials.

Customer Service and Communications:

1. Communicates with patients, insurance carriers and other outside entities in a professional manner. Identifies solutions and responds professionally to patient concerns, i.e., pleasant tone of voice, courteous language, etc. Uses appropriate grammar and demonstrates tact and diplomacy in patient interactions, by phone and in person.
2. Diffuses negative situations with patients and maintains a pleasant and professional tone during stressful circumstances and heavy workload.
3. Communicates with staff members in a professional, pleasant manner; Shares information relevant to work, no gossiping or disparaging remarks, accepts work without complaint or provides reasons why assignment is unmanageable, asks and answers questions related to improving department performance.

Teamwork:

1. Works cooperatively with coworkers, providers, and management.
2. Shares knowledge and insights with co-workers in a constructive manner.
3. Willingly provides coverage to department, staying beyond scheduled ending time when clinic schedule demands it, volunteering to cover time off or unexpected absences, maintaining workflow in department without direct supervision.
4. Addresses conflicts with person directly before involving manager or uninvolved peers.
5. Is considerate of others with regard to taking breaks or meal periods, use of computer and telephone, and noise in department.

Policies and Procedures:

1. Knows and complies with policies and procedures as enumerated in the Orthopedic One Employee Handbook and policies and procedures documents.
2. Provides assistance and support to leadership in implementing policies and procedures as necessary.
3. Actively participates in training, and conducting day to day work activity by adhering to all policies and procedures as enumerated in compliance and risk management programs.

High School Diploma or equivalent required with a minimum of five years of medical billing experience or an Associate’s Degree in Medical Billing and Coding or Health Information Management without prior experience. Certified Professional Coder (through AAPC) preferred. Candidates must be able to work with high volume of work while maintaining attention to detail and accuracy and demonstrate excellent oral and written communication skills. Computer skills required to operate practice management system (i.e., use Window operating system, conduct Internet searches, communicate by email, etc.).

Demonstrates general knowledge of medical terminology and insurance industry; Able to work with high volume of work while maintaining attention to detail and accuracy; Demonstrates excellent oral and written communication skills; Able to operate practice management system and other computer programs (i.e., use Windows operating system, conduct Internet searches, communicate by email, etc.); Able to operate a calculator to accurately perform basic math functions; Able to work cooperatively as a member of the Patient Accounts department to meet the needs of internal and external customers.