NSN Revenue Resources | A/R Revenue Cycle Specialist - ...

Overview: We are seeking an experienced and detail-oriented Accounts Receivable Specialist to join our central billing office team for ambulatory surgery centers. The successful candidate will play a crucial role in resolving outstanding surgical claims resulting in maximum reimbursement. Responsibilities: Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers including self-pay to obtain maximum reimbursement. Prioritize high dollar claim balances through work queues Review & work incoming insurance and patient correspondence including refund requests. Send appeals when appropriate or provide the requested medical documentation. Ability to review medical documentation to justify medical necessity. Review patient balances to ensure accuracy and follow up with patients to obtain payments. Take incoming patient phone calls to resolve inquiries, billing issues, or outstanding balances. Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents. Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD's) for claim resolution. Negotiate payment amounts for procedures with Third Party Administrators for out of network providers. Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation. Requirements 2+ years of ASC revenue cycle OR orthopedic collections experience is preferred. Strong understanding of medical billing and insurance reimbursement processes, including experience with denials and appeals. Ability to read and interpret insurance explanations of benefits and managed care contracts. Excellent interpersonal and communication skills. Must be able to multi-task and handle competing priorities while meeting or exceeding deadlines. Intermediate computer proficiency in Microsoft Office including Excel and Outlook. Advantx, Vision, HST, SIS Complete, or Waystar experience preferred. High School Diploma or equivalent is required.

Created: 2024-11-26