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AR Specialist III

POSITION SUMMARY: The AR Specialist III position reports directly to the Manager, Patient Financial Services. This position includes, but is not limited to billing, payer edits and rejections. Review of specific unpaid accounts in order to determine the status and required action needed to expedite payment by the third party payers. Denial Management and multi-level appeals.# This person will review insurance remittances and related correspondence and contact insurance carriers until the resolution of a payment or claim rejection has been received.# Upon analysis, appropriate adjustments will be made according to department policies and procedures.# # EDUCATION/CERTIFICATION ######## High school diploma or GED equivalent. # EXPERIENCE ######## Minimum 3 years of billing and third party collections, preferably in healthcare ######## Extensive follow-up knowledge of all Commercial and #Government payers ######## Billing knowledge of all Government and multiple third party payers ######## Denial management, analysis and multi-level appeals for all payers # COMPETENCIES ######## Must have strong organizational skills ######## Must be able to multi-task. ######## Ability to analysis and review reports to determine payer next-steps for under and overpayments. ######## Computer skills, including but not limited to Microsoft# Word and Excel. # ESSENTIAL DUTIES and RESPONSIBILITES: Disclaimer: Job descriptions are not intended, nor should they be construed to be, exhaustive lists of all responsibilities, skills, efforts or working conditions associated with the job.# They are intended to be accurate reflections of the principal duties and responsibilities of this position.# These responsibilities and competencies listed below may change from time to time. # # ######### Maintains a good working knowledge of 3rd party billing. ######### Works daily electronic billing file and submits insurance claims to third party payers. Reviews ############ daily edit reports from the hospital billing system and makes necessary corrections to allow electronic submission ######### Submits claims timely upon the billing process in order to avoid loss revenue based on contractual timely filing restrictions. ######### Monitors the rejections on the daily electronic submitted report and makes the necessary modifications to resubmit###### ######### Monitors claim rejections for trends and issues and reports findings to supervisor. ######### Reviews specific unpaid accounts listed on the Aged Trial Balance Report to determine action required to ensure payments by the third party payers. Performs adequate follow up in a timely manner. ######### Works effectively with Patient Access and HIM in order to reach accuracy benchmarks ######### Contacts third party payers to monitor the status on accounts with un-paid balances in order to determine the status of the claim and expedite payment. ######### Addresses insurance remittance and various correspondences to identify accounts with discrepancies in expected reimbursement according to the contractual rate. ######### Understands the methodology and payment schedule related to the assigned payer(s) regarding account follow up ######### Follows through with insurance payers until adequate resolution is received regarding the payment or rejection of a claim and submits first level appeals when necessary. ######### Documents accounts professionally with clear and concise information. ######### Makes appropriate adjustments to assigned accounts as necessary in a timely fashion and according to established PFS guidelines. Reclassifies accounts and appropriate balances to the third party payers and self pay financial classes ######### Monitors payment discrepancies and informs Supervisor/Management of all relevant issues as they arise. ######## Executes the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party payers in a timely manner ######## Conducts internal and external correspondence accurately, clearly, concisely, and professionally while following organizational regulations ######## Maintains data on the types of claims denied and root causes of denials, and ########### collaborates with team members to make recommendations for improvement and resolve issues ######### Displays team approach in regards to timely communication pertinent to payer updates and authorization information that is essential to other departments. #

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