Description
Job Description
Sutherland is seeking an analytical and attentive person to join us as an Accounts Receivable Associate. The accounts Receivable will be responsible for reporting, tracking payments and appealing denials. We are a group of driven and hard-working individuals. If you are looking to build a fulfilling career and are confident you have the skills and experience to help us succeed, we want to work with you!
Job Requirements:
- Strong attention to detail
- Ability to communicate in a clear and professional manner
- Thorough understanding of the revenue cycle process, from patient access (authorization, admissions) through Patient Financial Services (billing, collections) procedures and policies
- Has a full understanding of the Managed Care collections
- Familiar with terms such as MMC, HMO, PPO, IPA and Capitation and how these payers process claims
- Knowledge of Managed Care contracts, Contract Language and Federal and State requirements
- Intermediate understanding of Hospital billing form requirements (UB04) and HCFA 1500
- Medical claims and/or hospital collections experience
- Minimum high school education, technical training, and/or experience preferred to perform the job
Qualifications
Job Responsibilities:
- Responsible for performing payment follow up activity on patient accounts assigned
- Conduct collection activity on previously appealed claims by contacting government agencies, third party payers via phone, email, or online
- Continue collection activity until account is resolved, sent to Legal, or disputed
- Provide ongoing appropriate collection activity on appeals until the payer has responded to the appeal
- Ensure daily productivity standards of assigned accounts are met
- Request additional information from Patients, Medical Records, and others upon request from payers
- Communicate with insurance plans and research health plan for benefits and types of coverage
- Review contracts and identify billing or coding issues and request re-bills, secondary billing, or corrected bills as needed.
- Recognize payer delays and inform management of such delays in order to be addressed at the payer level
- Return accounts to Appeal Writers for next level appeals as needed
- Identify payer trends in payment delays and escalate issues to Supervisor
- Ensure compliance with State and Federal Laws Regulations for Managed Care and other Third Party Payers
- Provide ongoing appropriate collection activity on appeals until the payer has responded to the appeal
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