The Accounts Receivable Specialist, through various projects assigned by Management, is responsible for collecting outstanding accounts receivable from third party payers; both government and commercial. The Specialist anticipates and responds to a wide variety of issues/concerns and works independently to assist in creating and maintaining documentation of key processes.

At this time, US Anesthesia Partners does not hire candidates residing in California, Hawaii, or Alaska.

ESSENTIAL DUTIES AND RESPONSIBILITIES (include but not limited to):

• Performs advanced level work related to denial management.
• Processes and follows up on all appeal types, at an expert level, to all payers.
• Takes actionable steps to resolve open claims, as needed, including refiling or appealing claims, or resolving manual tasks assigned to AR for review.
• Works outstanding Accounts Receivable from assigned projects.
• Functions as a SME across multiple workflows and various payers.
• Provides peer payer and system training support.
• Identifies denial patterns and escalate to management for follow-up and/or root cause resolution.
• Makes recommendations to work queues and claim edits to improve efficiency and reduce denials.
• Reviews payer communications related to changes in medical and reimbursement policies.
• Researches payer trends identified by offshore partners to recommend training/process improvement.
• Identifies opportunities for and actively participate in process improvement initiatives.
• Maintains strictest confidentiality.
• Maintains basic proficiency with using spreadsheets.
• Maintains productivity and quality standards established by RCM.
• All other duties as assigned.

REPORTING TO THIS POSITION: No Direct Reports.

JOB REQUIREMENTS (Knowledge, Skills and Abilities):

• Excellent verbal and written skills to maintain professionalism in all methods of communication.
• Basic math skills for calculating anesthesia units, proper reimbursement, and percentages for appropriate adjustments.
• General understanding of medical terminology.
• Advanced knowledge of insurance processing, payer policies, guidelines, and explanation of benefits (EOB’s).
• Knowledge of Commercial payer, Medicare, and Medicaid guidelines.
• Data entry skills with high accuracy.
• General knowledge and understanding of CPT, ICD-10 and ASA codes.
• Good problem-solving skills.
• Decision making ability with sound judgment.
• Strong analytical skills and attention to detail, including gathering and aggregating information.
• Ability to work effectively with all team members, including physicians, and external vendors or patients.
• Must be able to work in a virtual team environment.
• Ability to work independently with limited supervision.
• Skill in computer applications including MS Word, MS Excel, MS Outlook, and MS Teams.

EDUCATION/TRAINING/EXPERIENCE:

• High-school graduate or equivalent.
• Associate or bachelor’s degree in business administration or related field of study is preferred.
• A minimum of 3 years Accounts Receivable experience preferred.

PHYSICAL REQUIREMENTS:

• Requires prolonged sitting, some bending, stooping and stretching.
• Must possess sufficient eye-hand coordination/manual dexterity to operate a keyboard, photocopier, telephone, calculator, and other office equipment.
• Required normal range of hearing and eyesight to record, prepare, and communicate appropriate reports and evaluations.
• Requires dexterity to type at least 50 wpm.

WORKING CONDITIONS (environment and safety):

• Work performed in a remote office environment.
• Involves frequent contact with professional staff and managed care organizations Work may be stressful at times
• Interaction with others is frequent and often disruptive.

DISCLAIMER: The above job description has been written to indicate the general nature and level of work performed by employees within this classification. It is not written to be inclusive of all duties, responsibilities and qualifications required of employees assigned to this job.

US Anesthesia Partners, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, gender identity, sexual orientation, pregnancy, status as a parent, national origin, age, disability (physical or mental), family medical history or genetic information, political affiliation, military service, or other non-merit based factors.