Riverside Healthcare
CERTIFIED ACCOUNTS RECEIVABLE SPECIALIST
Riverside Healthcare, Kankakee, Illinois, United States, 60901
CERTIFIED ACCOUNTS RECEIVABLE SPECIALIST
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CERTIFIED ACCOUNTS RECEIVABLE SPECIALIST
role at
Riverside Healthcare
Overview The Certified Accounts Receivable Specialist is responsible for pursuing reimbursement of services rendered and achieving accounts receivable resolution. This role involves resolving insurance carrier denials, appealing claims, contacting carriers regarding open accounts, and responding to insurance carrier correspondence and inquiries while demonstrating flexibility with assignments within professional scope/duties/licensure. The specialist will work with various payers, including Medicare, Medicaid, and commercial insurers, ensuring compliance with all relevant regulations.
Claims Management & Resolution
Consistently meet or exceed productivity and quality standards for claim edits, complaint claim submissions, and clinical documentation requirements.
Ensure timely filing of claims, resulting in clean, complete, and accurate submissions.
Perform timely follow-up on denials and appeals, including root cause analysis to reduce and prevent future denials while working to overturn denials for payment resolution.
Submit specialist provider appeals denied for medical necessity, coding/bundling issues, experimental, and technical reasons.
Coding & Charge Corrections
Analyze coding‑related denials to determine coding integrity and take appropriate actions, including charge corrections, appeals to payers, or submission to the Coding team for further review.
Perform charge corrections to add or modify appropriate CPT modifiers after reviewing physician documentation according to CPT guidelines.
Maintain the coding mailbox and handle necessary charge corrections identified by the coding/billing department, including modifications of modifiers, diagnosis codes, and CPT corrections.
Payer Interaction & Compliance
Maintain compliant follow‑up correspondence with third‑party payers regarding outstanding accounts receivables using various communication methods (e.g., statements, emails, faxes).
Understand and apply payer medical and coverage policies to determine the medical necessity of specialist procedures, surgeries, injections, and therapies.
Understand and adhere to Medicare billing requirements and those of other assigned payers as defined by contracts, state, or federal law.
Practice HIPAA privacy standards and ensure compliance with patient health information privacy practices.
Reporting & Analysis
Review and analyze coding‑related denials and report trends to management/sites for feedback to providers.
Identify opportunities for customer, system, and process improvements and submit them to management.
Update registration information, post denial codes, and adjustments in practice management systems.
Recommend accounts for contractual or administrative write‑offs with appropriate justification and documentation.
Customer Service & Support
Assist with overflow incoming customer service calls, billing, or payment posting when needed.
Provide excellent communication and service when dealing with patients, families, public, co‑workers, and professional offices.
Preferred Experience
Two years of college or a college degree.
Knowledge of Epic systems.
Required Licensure/Education
High school graduate or equivalent.
Physician coding certification (CPC through AAPC or CCA through AHIMA) within 6 months of hire.
At least 2 years of related work experience.
Working knowledge of physician billing and follow‑up, including an understanding of insurance rules and regulations.
Knowledge of HIPAA standards and the ability to perform mathematical calculations.
Excellent communication skills and basic knowledge of medical terminology and billing practices.
Extensive experience and knowledge of PC applications, including Microsoft Office and Excel.
Seniority Level Entry level
Employment Type Full‑time
Job Function Accounting/Auditing and Finance
Industries Hospitals and Health Care
Benefits and Compensation
Base compensation within the position’s pay range based on factors such as qualifications, skills, relevant experience, and/or training.
Premium pay such as shift differential, on‑call.
Opportunity for annual increases based on performance.
Paid Time Off programs.
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long‑Term Disability.
Health Savings and Flexible Spending Accounts for eligible health care and dependent care expenses.
Defined contribution retirement plans with employer match and other financial wellness programs.
Educational Assistance Program.
Pay Range: USD $24.12 – $29.50 per hour.
Referrals increase your chances of interviewing at Riverside Healthcare by 2x.
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CERTIFIED ACCOUNTS RECEIVABLE SPECIALIST
role at
Riverside Healthcare
Overview The Certified Accounts Receivable Specialist is responsible for pursuing reimbursement of services rendered and achieving accounts receivable resolution. This role involves resolving insurance carrier denials, appealing claims, contacting carriers regarding open accounts, and responding to insurance carrier correspondence and inquiries while demonstrating flexibility with assignments within professional scope/duties/licensure. The specialist will work with various payers, including Medicare, Medicaid, and commercial insurers, ensuring compliance with all relevant regulations.
Claims Management & Resolution
Consistently meet or exceed productivity and quality standards for claim edits, complaint claim submissions, and clinical documentation requirements.
Ensure timely filing of claims, resulting in clean, complete, and accurate submissions.
Perform timely follow-up on denials and appeals, including root cause analysis to reduce and prevent future denials while working to overturn denials for payment resolution.
Submit specialist provider appeals denied for medical necessity, coding/bundling issues, experimental, and technical reasons.
Coding & Charge Corrections
Analyze coding‑related denials to determine coding integrity and take appropriate actions, including charge corrections, appeals to payers, or submission to the Coding team for further review.
Perform charge corrections to add or modify appropriate CPT modifiers after reviewing physician documentation according to CPT guidelines.
Maintain the coding mailbox and handle necessary charge corrections identified by the coding/billing department, including modifications of modifiers, diagnosis codes, and CPT corrections.
Payer Interaction & Compliance
Maintain compliant follow‑up correspondence with third‑party payers regarding outstanding accounts receivables using various communication methods (e.g., statements, emails, faxes).
Understand and apply payer medical and coverage policies to determine the medical necessity of specialist procedures, surgeries, injections, and therapies.
Understand and adhere to Medicare billing requirements and those of other assigned payers as defined by contracts, state, or federal law.
Practice HIPAA privacy standards and ensure compliance with patient health information privacy practices.
Reporting & Analysis
Review and analyze coding‑related denials and report trends to management/sites for feedback to providers.
Identify opportunities for customer, system, and process improvements and submit them to management.
Update registration information, post denial codes, and adjustments in practice management systems.
Recommend accounts for contractual or administrative write‑offs with appropriate justification and documentation.
Customer Service & Support
Assist with overflow incoming customer service calls, billing, or payment posting when needed.
Provide excellent communication and service when dealing with patients, families, public, co‑workers, and professional offices.
Preferred Experience
Two years of college or a college degree.
Knowledge of Epic systems.
Required Licensure/Education
High school graduate or equivalent.
Physician coding certification (CPC through AAPC or CCA through AHIMA) within 6 months of hire.
At least 2 years of related work experience.
Working knowledge of physician billing and follow‑up, including an understanding of insurance rules and regulations.
Knowledge of HIPAA standards and the ability to perform mathematical calculations.
Excellent communication skills and basic knowledge of medical terminology and billing practices.
Extensive experience and knowledge of PC applications, including Microsoft Office and Excel.
Seniority Level Entry level
Employment Type Full‑time
Job Function Accounting/Auditing and Finance
Industries Hospitals and Health Care
Benefits and Compensation
Base compensation within the position’s pay range based on factors such as qualifications, skills, relevant experience, and/or training.
Premium pay such as shift differential, on‑call.
Opportunity for annual increases based on performance.
Paid Time Off programs.
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long‑Term Disability.
Health Savings and Flexible Spending Accounts for eligible health care and dependent care expenses.
Defined contribution retirement plans with employer match and other financial wellness programs.
Educational Assistance Program.
Pay Range: USD $24.12 – $29.50 per hour.
Referrals increase your chances of interviewing at Riverside Healthcare by 2x.
#J-18808-Ljbffr