Basic Function: The Accounts Receivable Representative
performs follow-up activities on claims under the direction of the
Accounts Receivable Manager. The Accounts Receivable Representative
may be assigned to perform essential Accounts Receivable Manager duties
in the Accounts Receivable Manager’s absence.
Job Relationships:
The Accounts Receivable Representative reports directly
to the Accounts Receivable Manager and interacts with payers, patients,
physicians, nursing staff and other facility personnel in all areas
pertaining to his/her position.
Job Qualifications:
* Education – High school diploma or equivalent required.
* Work Experience – A minimum of one year billing
office experience required. Knowledge of medical terminology and computer
literacy are required. Familiarity with payer contracts preferred.
* Skills – Basic office skills required; advanced
office skills preferred. Strong communication skills. Ability to identify
trends with regard to third party payer denials and proactively problem
solve.
* Physical Guidelines – Ability to extend wrists/arms
for up to eight hours/day; sit for up to eight hours/day; and work
at computer terminal for up to eight hours/day.
Core Duties:
* Performs claims follow-up by working assigned facilities’
aged trial balances under the direction of the Accounts Receivable
Manager.
* Coordinates resubmission of claims to third party
payers electronically or via hard copy mail with Coding & Billing
Department personnel when follow-up indicates such an action is necessary.
* Submits appeals with supporting documentation when
situation warrants such action.
* Identifies denial trends and works with claims representatives
in third party payer offices to resolve issues. When situation warrants,
enlists support and approval of Accounts Receivable Manager in escalating
issue/concern to provider representative in third-party payer’s
office and/or VP of Payer Relations.
Departmental Benchmarks:
* Works facility-specific aged accounts receivable
reports ensuring every account over 30 days old is reviewed monthly.
* Works denials received from third party payers within
48 hours of denial’s receipt.
Benchmarks:
* A/R days less than or equal to 40 days (except endoscopy
centers where A/R days should be less than or equal to 30 days).
