Payer AR Specialist II

Monitor payment status of claims submitted to assigned payers, which will include higher-volume commercial and/or government payers. Follow up with payer representatives to ensure timely payment is received. Track and complete follow up tasks as identified. In addition to monitoring accounts receivable, the Payer Accounts Receivable Specialist Level II should also be able to investigate and work denials or refund requests received from assigned payers. This role requires an individual that can manage and prioritize multiple tasks in order to meet deadlines and department goals. Finally, this Level II role will be expected to train new employees and should demonstrate the ability to recognize performance trends and recommend solutions to their leadership team. The Payer Accounts Receivable Specialist Level II will report to the Supervisor, Post-Claim and will have daily oversight provided by the Team Lead, Accounts Receivable and Denials. 

MINIMUM EDUCATION REQUIRED: High school graduate or equivalent 

MINIMUM EXPERIENCE REQUIRED: 

5 years or more experience in a physician billing office setting.  

Working knowledge of accounts receivable. 

Knowledge of Medicare, Medicaid, commercial insurance, workers' compensation, and other insurance industry operating procedures 

Proficient computer skills 

Basic knowledge of medical terminology and prior experience with ICD-9 or ICD-10, CPT, and HCPCS coding is preferred 

Proficiency in filing and collecting insurance claims from individual carriers or agencies 

MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW: None Required 

ADDITIONAL PREFERRED QUALIFICATIONS: 

Possess effective verbal and written communication skills, demonstrates a sincere commitment to high quality customer service. 

Self-motivated and able to work efficiently without direct supervision or continuous instruction 

Ability to prioritize and manage multiple tasks simultaneously, and to effectively anticipate and respond to issues as needed in a dynamic work environment.  

Ability to work well with others 

A demonstrated ability to use PC based office productivity tools (e.g. Microsoft Outlook, Microsoft Excel, Word) as necessary; general computer skills necessary to work effectively in an office environment.  

Requires extensive length of time sitting for telephone interactions and data entry. Requires ability to use office equipment (telephones, fax/copier, etc.). 

Dedication to treating both internal and external constituents as clients and customers, maintaining a flexible customer service approach and orientation that emphasizes service satisfaction and quality.  

KEY RESPONSIBILITIES:   

AR follow-up and denials responsibility for assigned payers and work queues 

Larger, higher-volume commercial payers and/or government payers; ability to manage both 

Ability to validate recoupments or refund requests 

Demonstrate the ability to recognize and report trends as well as recommend solutions; ability to partner with other business office or practice representatives to prevent denials or follow-up issues 

Ensure tasks are managed and properly documented within practice management system work queues; maintain productivity standards set by post-claim leadership team 

Strive for a positive customer service experience 

Maintain reception desk/work areas  

Comply with all federal, state, or other regulatory requirements. 

Adhere to Floyd Healthcare Management Inc. organizational policies and procedures for relevant location and job scope.  

Other miscellaneous duties as assigned.