Representative, CBO Specialty A/R

Specialty A/R Representative, CBO

About MedSrv
As the healthcare industry continues to grow, so does the need for consistent, effective Revenue Cycle Management. But it takes more than just technology and technical expertise. It takes innovation, a willingness to adapt, and passion to deliver the best. MedSrv, LLC is the difference in Revenue Cycle Management.
We?re looking for a Specialty A/R Insurance Representative to join our growing team. The Specialty Insurance A/R Follow-up Representative will be responsible for reviewing unpaid, underpaid, denied or unresolved insurance balance patient accounts submitted to various health care payers. If you're ready to contribute to our mission of guiding by faith and serving with integrity and compassion, we want to hear from you! Join the MedSrv team and be part of a company committed to excellence in Revenue Cycle Management.

Schedule: Full-time
Location: Remote
Compensation: $19.00/hr.

Benefits for you and your family:
? Paid time off
? Full benefits package
? Matching 401k plan
? Balanced work-life schedule ? NO WEEKENDS!
? Casual work environment
? Career Development

In this role, you will:
Read, and understand with proficiency, and interpret Explanations of Benefits (EOBs) from various insurance carriers. Familiar with medical terminology, including CPT and ICD-10 codes. Solid experience in processing claims and managing insurance appeals and disputes. Serves as the main liaison between health insurance and healthcare systems. Skilled in using payer websites/portals to check insurance guidelines, claim statuses, and eligibility requirements. Adept at handling authorization denials and conducting follow-ups. Capable of employing various systems/platforms for research and analytical purposes.

You will bring value to the team by:
? Follow up on unpaid claims using payer websites and/or AVR, ensuring thorough completion of assigned claims, including actions taken for reprocessing or appeals.
? Work on accounts receivable reports, as assigned, completing them according to provided work instructions and notifying the supervisor if unable to meet timeframes.
? Meet production quotas for new employees after coaching/mentorship:
? 30-day goal: 20 claims per day
? 60-day goal: 30-35 claims per day
? Maintain productivity standards after 90 days of employment:
? Denial Reps: Minimum of 50 claims per day for Managed Care, Medicare, Medicaid, and other payers.
? Medical Records Reps: Minimum of 30 claims per day.
? Escalate claims to the correct coding contacts for necessary corrections, providing appropriate details.
? Forward and provide updated information to the supervisor.
? Know client specialties, locations, and proper A/R information.
? Communicate claim trends resulting in denials or decreased payments to management, including payer, provider(s), number of claims, and dollar amount affected.
? Keep management informed of client communication and correspondence issues.
? Meet established goals within 90 days of continuous employment.
? Maintain concentration for extended periods.
? Cooperate and function as a team member.

Specialty A/R Specific Expectations:
? Reference the Surgery Center Rate Matrix for reviewing partial payments and/or denials.
? Conduct initial reviews of ASC claims 15 days after the bill date and every 15 days thereafter until the claim balance is closed.
? Understand claims splitting as it applies to ASC billing.
? Determine the appropriate claim form for ASC billing at the payer level.
? Demonstrate a strong, knowledgeable, and organized approach when pursuing payment from insurance companies, aiming to resolve balances in a "one touch" manner.
? Produce thorough and detailed notes explaining claim status, next steps, appeal rights, partial payment information, etc.
? Strong verbal and written communication skills to interact with insurance providers and healthcare clients.
? Ability to use multiple systems/platforms for research and analysis.
? Producing thorough and detailed notes on claim status, next steps, and appeal rights.
? Ability to manage tasks promptly and meet production quotas.
? Escalating claims for necessary corrections and resolving issues efficiently.

Requirements you must have for success:
? High school diploma or equivalent required.
? Relevant work experience in AR/Medicaid/Commercial health insurance processes.
? Demonstrated customer service experience in a customer service-oriented environment.
? Reliable and predictable attendance.
? Strong verbal/written communication and interpersonal skills.
? Computer proficiency.
? Self-directed with the ability to work both as part of a team and individually.
? Adaptability to work effectively in a continuously changing environment.
? Professionalism and a strong work ethic that positively influences teamwork habits.

Language Skills:
Ability to: read and comprehend complex instructions, correspondence, and memos; write and present information to leadership, vendors, clients, and other employees of the organization.
Mathematical Skills:
Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Have the ability to compare rate, ratio, and percent and to draw and interpret various graphs.
Reasoning Ability:
Ability to: deal with problems involving several concrete variables in standardized situations; plan, organize, delegate, and prioritize work; provide clear and effective direction to staff; communicate effectively orally and in writing; establish and maintain effective working relationships with MedSrv departments, vendors, other businesses, and our clients; Must be able to multi-task.
Physical Demands:
You may be required to lift between 30-50lbs at times. Limited.
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. The noise level in the work environment is usually moderate.

We are an equal-opportunity employer and believe in the power of a diverse, inclusive team. We welcome all applications from all suitably qualified people, regardless of race, sex, disability, religion/ belief, sexual orientation, or age. Please let us know if you require anything which would enable your success throughout our interview process.

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