At UHS, we're looking for exceptional people who share our vision and values, who share our focus on hard work, enthusiasm, teamwork, loyalty, trust and cooperation. We've embraced these traits and built a team of employees who consistently work to achieve the highest level of service excellence. People are our most valuable resource at UHS as we are committed to providing high quality acute care and behavioral health services to residents of the communities we serve. We are equally committed to offering our employees unlimited opportunity in an environment that encourages professional development.
The Accounts Receivable Specialist is responsible for the accurate and timely follow-up of unpaid claims, by assigned payer/s and defined aging criteria to meet or exceed collection targets and minimize write-offs. Researches claim denials by assigned payer/s to determine reasons for denials correcting and reprocessing claims for payment in a timely manner. Meets or exceeds established performance targets (productivity and quality) established by the A/R Supervisor. Initiates and follows-up on appeals recognizing the payer defined aging criteria. Exercises good judgement in escalating identified denial trends or root cause of denials to mitigate future denials, expedite the reprocessing of claims and maximize opportunities to enhance front end claim edits to facilitate first pass resolution. Identifies uncollectible accounts and performs accurate and timely write-offs (e.g. no authorization) adhering to IPM CBO policy guidelines. Demonstrates the ability to be an effective team player. Upholds "best practices" in day to day processes and work flow standardization to drive maximum efficiencies across the team.
Accurate and timely claims follow-up by assigned payer/s and defined aging criteria to meet or exceed collection targets and minimize timely filing write-offs. Performs eligibility and claim status follow-up inquiries utilizing outbound calls to the payer, web link tools and payer websites. Effectively documents claim status and next steps in the Practice Management System (PMS) to expedite timely and accurate claims processing. Meets or exceeds established performance targets (productivity and quality) established by the Accounts Receivable (A/R) Supervisor.
Accurate and timely research of claim denials by assigned payer/s. Works with payer to determine reasons for denials; corrects and reprocesses claims for payment in a timely manner. Proceeds with appeals process as needed. Meets or exceeds established performance targets (productivity and quality) established by the A/R Supervisor.
Identifies root causes and denial trends and works with the payer Customer Service Department to reprocess claims for payment. Escalates, as needed, to the Accounts Receivable (A/R) Supervisor to address at the payer Provider Representative level as needed.
Extensive and current working knowledge of government, managed care and commercial insurances, claim submission requirements, reimbursement guidelines, and denial reason codes.
Performs accurate and timely write-offs (e.g. no authorization) following identification of uncollectible accounts adhering to IPM CBO policy guidelines.
Effectively prioritizes work assignment/s and demonstrates flexibility in assuming payer specific A/R claim follow-up and denial management assigned to another A/R Specialist to ensure the team is meeting or exceeding department goals.
Participates in regularly scheduled team meetings sharing denial trends specific to claim requirements to enhance front end claim edits to facilitate first pass resolution. Contributes ideas for work flows and approaches to A/R follow-up tasks to maximize opportunities for performance, process and net revenue collections improvement.