The Accounts Receivable Specialist II is responsible for ensuring the timely collection of outstanding government or commercial healthcare insurance receivables.

Responsibilities:

• Verifies or obtains patient eligibility and/or authorization for healthcare services performed by searching payer web sites or client eligibility systems, or by conducting phone conversations with the insurance carrier or healthcare providers. 

• Updates patient demographics and/or insurance information in appropriate systems. 

• Conducts research and appropriately statuses unpaid or denied claims.  

• Monitors claims for missing information, authorization and control numbers (ICN//DCN). 

• Researches EOBs for payments or adjustments to resolve claims. 

• Contacts payers by phone or through written correspondence to secure payment of claims. 

• Acces client systems for information regarding received payments, open claims and other data necessary to resolve claims. 

• Follows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems. 

• Secures medical documentation as required or requested by third party insurance carriers. 

• Obtains billing guidelines and requirements by researching provider billing manuals.  

• Writes appeal letters for technical appeals. 

• Verifies accuracy of underpayments by researching contracts and claims data. 

• In the event of an authorization, coding, level of care and/or length of stay denial, prepares claims for clinical audit processing.  

• Support' s Compliance Program by adhering to policies and procedures pertaining to HIPAA, FDCPA, FCRA, and other laws applicable to Savista's business practices. This includes: becoming familiar with Savista's Code of Ethics, attending training as required, notifying management or Savista's Helpline when there is a compliance concern or incident, HIPAA-compliant handling of patient information, and demonstrable awareness of confidentiality obligations. 

Requirements:

• High school diploma or GED. 

• At least two years of experience in healthcare insurance accounts receivable follow up, working with or for a hospital/hospital system, working directly with government or commercial insurance payers. 

• Experience identifying billing errors and resubmitting claims as well as following up on payment errors, low reimbursement and denials. 

• Experience reviewing EOB and UB-04 forms to conduct A/R activities. 

• Knowledge of accounts receivable practices, medical business office procedures, coordination of benefit rules and denial overturns and third-party payer billing and reimbursement procedures and practices.  

• At least two years of experience with accounts receivable software.

• Experience navigating payer sites for appeals/reconsiderations, benefits verification and online claims follow up. 

• Demonstrated ability to navigate Internet Explorer and Microsoft Office, including the ability to input and sort data in Microsoft Excel and use company email and calendar tools. 

• Demonstrated success working both individually and in a team environment. 

• Demonstrated experience communicating effectively with payers, understanding complex information and accurately documenting the encounter. 

• Ability to work effectively with cross-functional teams to achieve goals. 

• Demonstrated ability to meet performance objectives. 

• This role is remote for candidates based in the following states: Alabama, Colorado, Florida, Georgia, Idaho, Kansas, Maine, Virginia, Vermont, Michigan, North Carolina, and South Carolina.