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Medical Insurance AR Specialist

Company: Lags Spine and Sportcare Medical Centers Inc
Location: Santa Maria
Posted on: February 13, 2020

Job Description:

Description: We are looking for a well-rounded Medical Insurance Claims AR Specialist. Ideal candidate hasminimum 2 years strong hands on claims review and clean up, as well as application of ICD-10, CPT, andHCPCS coding systems and E&M Auditing and Chart Auditing.Candidate must have the ability to review contracts for correct reimbursement, understand how to analyzeERAs, EOBs and other information to identify underpayments, non-payments and denials and how to workthrough to get claims resubmitted and paid. Candidate must also be able to identify trends that can be workedas a project to help capture revenue that would otherwise be written off or lost due to timely filing delays orpayer incorrect application of contractual agreements or incorrect processing of claims.Lags Medical offers a comprehensive benefit package that includes medical, dental, vision, 401k, PTO plan, 11 paid holidays, opportunities for career growth and more. . Requirements: Knowledge, Skills and Abilities:1) Knowledge and strong hands on application of claims review and clean up2) Knowledge and strong hands on application of ICD-10, CPT and HCPCS coding systems3) Knowledge and strong hands on application of chart review and documentation auditing4) Knowledge of health insurance programs, coverage offered and third-party reimbursement mechanisms,including Medicare, Medi-Cal, PPO, HMO, IPA, PMG, Military and Veteran, Workers Compensationand their billing guidelines and processes5) Knowledge of various payer Provider Dispute Resolution, First and Second Level appeal processes6) Knowledge of various payer medical necessity guidelines and/or how to obtain these7) Knowledge in interpretation of Claims Aging and Financial Analysis Reporting8) Knowledge of electronic medical record systems9) Knowledge of manual and electronic billing systems and procedures10) Knowledge of eligibility, benefits and authorizations processes11) Knowledge of general office procedures to create efficient and positive work environment12) Skill in communicating effectively to peers, supervisors and patients and to handle stressful situationsappropriately13) Skill in operating personal computer utilizing word processing, spreadsheets, databases, email and otheroffice equipment14) Audits insurance information for appropriateness in current billing system and is able to quickly identifyunderpayments or other trends that may negatively affect cash flows15) Ability to prioritize work and able to work with little or no supervision16) Ability to communicate both verbally and written effectively and efficiently17) Ability to maintain confidentiality of information, most importantly patient financial and medicalinformation18) Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form19) Follows timely filing guidelines per payer to ensure maximum payment20) Ability to understand and respond appropriately, effectively, sensitively to special population groups asdefined by race, ethnicity, language, age, sex, etc.21) Ability to hear and speak well enough to converse over telephone22) Ability to see well enough to use computer efficiently and read computer reports and correspondence23) Strong Excel, Word and Power Point skills24) Willingness to learn, understand and abide by company policies and proceduresProductivity:1) Ensures billing of services meet standards set by medical corporation, federal and/or state guidelines2) Uses good judgment when auditing, preparing and submitting PDRs and Appeals to other entities forpayment3) Completion of daily, weekly and added special projectsQuality Management:1) Constantly alert for ways to improve customer service, improve patient flow, increase productivity, andimprove utilization of resources communicating ideas to supervisor2) Maintains infrequency of denied appeals in the AR process3) Ensures that electronic and hard copy claims are accurate and completed on time.4) Verifies and ensures competency when utilizing EMR and Billing systems5) Uses mathematical accuracy and attention to detail6) Audits of invalid/rejected edits for accuracy in the electronic claim submission process7) Ensures provider correction requests are responded back to billing timely8) Notifies supervisor of unusual occurrences and adheres to policy regarding incident forms and/or patientcomplaints9) Attends and actively participates in staff meetings as requested10) Attends and actively participates in staff trainings, webinars and seminars as requestedReliability:1) Positively supports requests from administrative office and supervisor in implementing policy and newprograms2) Dependable and punctualCustomer Service:1) Sets the example of exemplary patient and insurance customer service2) Responds to patient or insurance representative calls in a professional manner3) Reviews the terms of service performed, sliding fees, third party payments and payment collection withpatient via telephone4) Ensures cleanliness of work environment during operational hours and is always prepared to providefriendly assistance to patients, insurance and staff members

Keywords: Lags Spine and Sportcare Medical Centers Inc, Santa Maria , Medical Insurance AR Specialist, Healthcare , Santa Maria, California

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