Accounts Receivable Escalation Specialist

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Medsuite Inc

WebsiteLinkedInAll Job Openings

1 - 10 employees

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare Insurance • SaaS • HealthTech

Medsuite Inc. is a digital platform designed to streamline healthcare management and improve patient care. It provides tools for healthcare providers to manage patient records, appointments, and communications efficiently, all while prioritizing user-friendly access for patients and providers alike.

📋 Description

• The Accounts Receivables Escalation Specialist are primarily responsible for analyzing collections, resolving non-payables, and handling bill inquiries for more complex issues • AR Representatives are responsible for insurance payer follow-up ensuring claims are paid according to client contracts • Complies with all applicable laws regarding billing standards • Follows up on claim rejections and denials to ensure appropriate reimbursement for our clients • Process assigned AR work lists provided by the manager in a timely manner • Write appeals using established guidelines to resolve claim denials with a goal of one contact resolution • Identified and resolved denied, non-paid, and/or non-adjudicated claims and billing issues due to coverage issues, medical record requests, and authorizations • Recommend accounts to be written off on Adjustment Request • Reports address and/or filing rule changes to the manager • Check the system for missing payments • Properly notates patient accounts • Review each piece of correspondence to determine specific problems • Research patient accounts • Reviews accounts and determines appropriate follow-up actions (adjustments, letters, phone insurance, etc.) • Processes and follows up on appeals • Files appeals on claim denials • Scan correspondence and index to the proper account • Inbound/outbound calls may be required for follow-up on accounts • Respond to insurance company claim inquiries • Communicates with insurance companies about the status of outstanding claims • Meet established production and quality standards as set by Ventra Health • Performs special projects and other duties as assigned

🎯 Requirements

• High School Diploma or GED • At least one (1) year in the data entry field and one (1) year in medical billing and claims resolution preferred • AAHAM and/or HFMA certification preferred • Experience with offshore engagement and collaboration desired • Intermediate level knowledge of medical billing rules, such as coordination of benefits, modifiers, Medicare, and Medicaid, and understanding of EOBs • Become proficient in the use of billing software within 5 weeks and maintain proficiency • Ability to read, understand and apply state/federal laws, regulations, and policies • Ability to communicate with diverse personalities in a tactful, mature, and professional manner • Ability to remain flexible and work within a collaborative and fast-paced environment • Basic use of a computer, telephone, internet, copier, fax, and scanner • Basic touch 10 key skills • Basic Math skills • Understand and comply with company policies and procedures • Strong oral, written, and interpersonal communication skills • Strong time management and organizational skills • Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills.

🏖️ Benefits

• As part of our robust Rewards & Recognition program, this role is eligible for our Ventra performance-based incentive plan • Help Us Grow Our Dream Team — Join Us, Refer a Friend, and Earn a Referral Bonus!