Account Resolution Specialist III - HB/PB

Job Overview

Job Duties and Responsibilities

• Perform tasks to generate revenue through account resolution for any Company client.
• Work with clients across Flex Workforce organization.
• Resolve escalated and/or stalled claims.
• Provide training and support to ARS Is and ARS IIs to improve quality and productivity.
• Mentor ARS Is and ARS IIs to increase skill levels.
• Submit claims in accordance with Federal, State, and payer mandated guidelines.
• Comply with productivity standards while maintaining quality levels.
• Responsible to research, analyze, and review claim errors and rejections and make applicable corrections.
• Ensure that claims submitted to payers are not returned nor denied due to controllable error.
• Maintain required knowledge of payer updates and process modifications to ensure accurate claims.
• Investigate, follow up with payers, and collect on insurance accounts receivables.
• Verify that accounts display accurate liability and balance with payer.
• Identify any payer specific issues and communicate to team and manager.
• Perform operations workflow training for new hires.
• Perform quality audits during training for new hires.
• Participate and contribute to daily shift briefings.

Qualifications

• Bachelor’s degree in Revenue Cycle Management or related field preferred.
• 3-5 years of experience working with health insurance companies in securing payment for medical claims.
• 3-5 years of experience with hospital and/or physician claim follow up and appeals with health insurance companies.
• Experience with multiple systems, e.g., Epic preferred.
• Expertise with computer including Microsoft Office Suite/Teams and GoToMeeting/Zoom, etc.

Knowledge, Skills, and Abilities

• Knowledge of ICD-10 Diagnosis and procedure codes and CPT/HCPCS codes
• Knowledge of rules and regulations relative to Healthcare Revenue Cycle administration
• Skilled in medical accounts investigation.
• Skilled in achieving results with little to no oversight.
• Skilled to investigate and resolve escalated claims
• Skilled in research to identify new rules and regulations relative to Healthcare Revenue Cycle administration
• Ability to validate payments
• Ability to make decisions and take action.
• Ability to maintain a positive outlook, pleasant demeanor, mature nature during all interactions, and act in the best interest of the organization and the client.
• Ability to take professional responsibility for quality and timeliness of work product.