The Accounts Receivable Specialist – RCM is responsible for collecting outstanding accounts receivable from third party payers through various projects assigned by management; both government and commercial. This role 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.

The base pay estimate for this role is $18.17 - $29.04 hourly. The final offer will depend on the skills, experience, and qualifications of the selected candidate. This range is for base pay only and does not include bonuses or other compensation. This position is eligible for a quarterly bonus. Bonuses are not guaranteed and are awarded based on company and individual performance.

ESSENTIAL DUTIES AND RESPONSIBILITIES: (The ideal candidate must be able to complete all physical requirements of the job with or without a reasonable accommodation)

• 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 an SME across multiple workflows and various payers.
• Provides peer payer and system training support.
• Identifies denial patterns and escalates 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 participates 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.

KNOWLEDGE/SKILLS/ABILITIES (KSAs)

• High school graduate or equivalent.
• Associate or bachelor’s degree in business administration or related field of study preferred. 
• Minimum of 3 years accounts receivable experience preferred.
• 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.
• Computer application skills to include MS Word, MS Excel, MS Outlook, and MS Teams.

*The physical demands described here are representative of those that may need to be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Occasional Standing
• Occasional Walking
• Frequent Sitting
• Frequent hand, finger movement
• Use office equipment (in office or remote)
• Communicate verbally and in writing

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.