AR and Denial Lead

Summary / Objective

• Review and oversee accounts receivable reports / queues daily.
• Assist in training best practices and AR management processes.
• Manage patient account(s) to ensure accurate and timely filing of all claims.
• Research unpaid and denied insurance claims in an expeditious manner to ensure account resolution and claim payment.
• Verify accuracy and completeness of documentation included with paper claims prior to submission.
• Initiate appeals and/or refile claims for all denials.
• Request refunds according to LBJI policies and guidelines
• Act as internal resource for staff questions
• Have an in-depth understanding of insurance rules and regulations, CPT/ICD10 coding information, explanation of benefits and company billing procedure(s)
• Develop and establish network connections with insurance provider representative(s) as well as other critical department(s) within insurance carrier(s)
• Communicate with team member(s) and the Revenue Cycle Director billing issue(s), insurance process(es) and denial trends. Present problems to team with a solution-based approach
• Coordinate with insurance carriers to obtain electronic payments and remittances for payments to LBJI.
• Meet and respond to patient requests for assistance and/or questions regarding financial accounts, insurance payment and patient balances.
• Review insurance carrier newsletters, mailing and announcements share updates with the billing department and A/R Specialist Supervisor
• Maintain confidentiality and compliance with HIPAA rules and regulations.
• Maintains LBJI handbook policy and reports any violations to appropriate management.
• Attend meetings as required.
  
  

Other duties as assigned

COMPETENCIES

• Knowledge of CPT and ICD-10 codes
• Knowledge of an Explanation of Benefits
• Teamwork and conflict resolution
• Adaptive and flexible
• Professionalism and work ethic
  
  

SUPERVISORY RESPONSIBILITY

N/A

WORK ENVIORNMENT

Work is performed in an office environment. Involves frequent contact with patients, physicians, and other healthcare personnel. Work may be stressful at times. Interaction with others is constant and interruptive. It is possible work may involve interaction with injured or sick patients.

TRAVEL

While performing the duties of this job, the employee may be required to sit and/or stand for prolonged periods, work longer than eight (8) hour shifts, and to work both day/evening shifts. Work may hand dexterity as well as the need to reach, climb, balance, stoop, kneel, crouch, talk, and hear. The employee must occasionally lift and/or move up to 50 lbs. While performing the responsibilities of the job, the employee is required to talk and hear. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to focus. Reasonable accommodation can be made to enable people with disabilities to perform the described essential functions of the job.

No travel outside of travel between Lakeshore Bone and Joint Institute location is expected for this position.

Role Qualifications

• Must be at least 18 years of age
• Must have reliable transportation
• Proficiency in Microsoft Word, Excel, and Outlook
  
  

Digital literacy

Preferred Experience Requirements

Minimum of 2-year medical insurance experience preferred.

Minimum Education Requirements

High school diploma or the equivalent.

Required

SKILLS

• Ability to analyze situations and solve problems
• Employ critical thinking and problem solving
• Ethical reasoning and decision making
• Strong attention to detail
• Receptive and responsive to feedback
• Excellent verbal and written communication skills
• Time management, prioritization, and sense of urgency
• Maintain patient confidentiality
  
  

Physical Requirements

While performing the duties of this job, the employee may be required to sit and/or stand for prolonged periods, work longer than eight (8) hour shifts, and to work both day/evening shifts. Work may hand dexterity as well as the need to reach, climb, balance, stoop, kneel, crouch, talk, and hear. The employee must occasionally lift and/or move up to 50 lbs. While performing the responsibilities of the job, the employee is required to talk and hear. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to focus. Reasonable accommodation can be made to enable people with disabilities to perform the described essential functions of the job.

• All employees have a responsibility to comply with our organization's policies, procedures, and code of conduct.