Impekkable/HealthTech is looking for a seasoned Hospital Accounts Receivable Specialist to join our team and support our managed hospitals.

100% Remote, Permanent, Full-time
Must have hospital complex claims and denials experience
ZERO micro-management – Must be able to work independently and stay on task

SUMMARY

This role is responsible for capturing reimbursement for hospital billed claims and denials. The ideal candidate must have a minimum of 3 years of hospital collections/claims/denials experience and possess a strong knowledge of Commercial, Third-Party Insurance Accounts, including but not limited to Medicaid, Managed Care, and Other Government payors. They must also have an in-depth understanding of payor contracts to include rules and guidelines governing payor collection activities and be able to “work” accounts in a computerized automated environment.

This person’s focus will be on 61+ A/R at a Critical Access Hospital.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Validate denial reason and ensure coding is accurate and reflects denial reasons for accounts that are under or partially paid.
• Maintain patient account records and resolve third party payer issues.
• Responsible for accurate billing, timely submission of electronic and/or paper claims, monitoring claim status, researching rejections and denials, documenting related account activities, posting adjustments and collections of Medicare, Medicaid, Medicaid Managed Care, and commercial insurance payers.
• Exhibit expertise in the billing system to guarantee that all features are employed for the most effective processing of claims.
• Responsible for correcting, completing, and processing claims for all payer codes;
• Analyze and interpret that claims are accurately sent to insurance companies.
• Perform follow up with Medicare, Medicaid, Medicaid Managed Care, and Commercial insurance companies on unpaid insurance accounts identified through aging reports.
• Process appeals online or via paper submission.
• Assist in reconciling deposits and patient collections.
• Assist with billing audit related information.
• Process refund requests.
• Generate an appeal based on the dispute reason and contract terms specific to the payor. This includes online reconsideration.
• Follow specific payor guidelines for appeal submission.
• Research contract terms/ interpretation and compile necessary supporting documentation for appeals.
• Ensure proper account documentation, which is clear, concise, and includes all pertinent information.
• Conduct daily calls to payors to obtain payment resolution and account status information.
• Understand and apply the terms of client’s contracts.
• Consistently follow established processes and procedures for all assigned accounts and projects to ensure prompt payments and account resolutions.
• Make appropriate and necessary corrections to patient account information as needed to ensure timely payment through appeal, reconsideration, rebilling.
• Escalate immediate and appropriate payor trends and issues to management which impact cash, aging, and processes.
• Maintain or exceed 95% of established productivity goals and quality standards (50 to 80 accounts).
• Utilize company software in all account follow-up activities and promote working toward paperless environment.
• Ensure professional verbal and written communication with facilities, clients, and co-workers following established guidelines.
• Obtain management approval when necessary to communicate with external clients about internal processes and procedures.
• Follow and maintain patient, account, and client confidentiality always.
• Adhere to HIPAA and Compliance Policy Guidelines.
• Follow timekeeping and attendance policy daily.

OTHER DUTIES AND RESPONSIBILITIES

• Perform other duties as assigned.
• Provide leadership to others through example and sharing of knowledge and skill.
• Comply with all company policies and procedures, including the corporate compliance program.
• Actively promote HealthTech/Impekkable in all interactions with customers.
• Act in accordance with company stated values – integrity, initiative, respect, personal commitment, excellent performance, and customer satisfaction.

EDUCATIONAL AND EXPERIENCE REQUIREMENTS

• High school diploma or GED required.
• Must have hospital complex claims and denials experience
• Knowledge of Commercial, Third-Party Insurance Accounts including but not limited to Medicaid, Managed Care, and Other Government Rules and Guidelines governing collection activities.

COMPUTER OPERATIONS

• Previous experience should include basic computer knowledge.
• Knowledge of Microsoft Word and Excel required.
• Working accounts in a computerized automated environment.

OTHER SKILLS AND ABILITIES

• Use independent and critical thinking skills to achieve assigned objectives.
• Able to organize and prioritize.
• Attention to detail.
• Must be accurate and timely.
• Good decision-making skills required.
• Able to maintain confidential information.