Who We Are:
The Translational Pulmonary & Immunology Research Center (TPIRC) is a cutting-edge research and clinical care center that is revolutionizing treatment for rare and orphan diseases. Through the use of comprehensive diagnostic tools and patient-driven research, we seek to improve the quality of life for children and young adults each and every day.
Why TPIRC?
TPIRC is home to many innovative thinkers, problem solvers, and passionate leaders. The work we do is truly life-changing for our patients and their families; each member of our team will experience how their role supports our mission! TPIRC provides a challenging and rewarding environment where employees’ talents are leveraged, ideas are encouraged and growth is always inspired.
Who Are We Looking For?
We are seeking a Medical AR Specialist. The Medical AR Specialist is responsible for researching and resolving outstanding account receivables for TPIRC’s patient population. This role works directly with patients, insurance companies, financial counselors, scheduling, business office, and clinical departments to execute all aspects of the revenue cycle process efficiently and accurately. This individual is responsible for maximizing revenue by providing appropriate follow-up of outstanding receivables. The Medical AR Specialist will demonstrate knowledge in all areas of the medical billing process and will serve as the collections and claims appeals expert for the organization.
Benefits:
Health Insurance
Vision Insurance
Dental Insurance
PTO Days
Paid Holidays
401K Plan (matched)
Professional Development
Paid Training
Company Sponsored Events
Competitive Rates
Growth Opportunities
Essential Functions: Eligibility and Benefits Verification:
Perform eligibility and benefits inquiries for both new and established patients, as needed.
Enter and make the appropriate changes in the EMR/PM system(s) and Salesforce regarding guarantor, payor, insurance eligibility and benefits coverage.
Determine and update copayment, coinsurance, deductible, and out-of-pocket amounts.
Verify eligibility and benefits using a real-time system response, through health plan portals, and/or via telephone to the health plan and/or guarantor.
Responsible for verifying COB information and communicating with the health plan and/or guarantor.
Collections:
Manage a portfolio of assigned accounts that are aged in a timely manner.
Maximize revenue by providing appropriate follow-up and document actions taken.
Ability to read and interpret an explanation of benefits.
Knowledge of a CMS-1500 claim form and field requirements.
Effective appeal writing skills to submit claim appeals with supporting documentation per payor policy/guidelines.
Monitor and maintain revenue integrity through appropriate account adjustments, small balance write-off and payment reconciliations.
Reconcile customer disputes as they pertain to payment of outstanding balances.
Respond to correspondence timely.
Heavy telephone contact to ensure timely follow-up and account resolution, and customer service phone coverage.
Daily productivity standards and quality standards must be met.
Manage credit balances and refunds.
Document instructions for the RCM team in the EMR/PM system(s) and Salesforce.
Respond to and resolve patient statements and claim tickets via Salesforce.
Respond to emails and phone calls related to patient statements and claims.
Performs job duties with oversight.
Other duties as assigned.
General:
Collaborate with patients or customers, third party institutions and other team members to research and resolve billing inconsistencies and errors.
Collect and maintain patient demographic and medical information required for medical billing.
Ensure patient documentation is scanned and filed correctly within the Electronic Medical Record (EMR).
Provide exceptional customer service.
Maintain and understand various medical billing software platforms.
Navigate insurance websites and answer customer inquiries.
Understand office visit fees including procedure and diagnosis codes.
Maintain confidentiality and adhere to HIPAA regulations.
Complete assigned tickets as required.
Adhere to policies and procedures, update of forms and manuals.
Assist in development and communication of SOP for key areas to improve accuracy and understanding of processes.
Support daily, weekly, and monthly medical billing metrics.
Identify issues and present possible solutions and/or suggestions to management.
Interfaces with other departments to resolve medical billing workflows.
Assist other staff and support the team approach.
Communicate appropriately and clearly to management, co-workers, and physicians.
Maintain all reference material that is provided by the supervisor, manager, or director.
Know and follow the Employee Handbook policies and procedures.
Maintain patient confidentiality so that HIPAA compliance is always observed.
Demonstrate honesty and integrity in everyday activities.
Arrive to work on time.
Consistently be at work.
Qualifications:
High School diploma or equivalent required.
Customer Service experience required
Medical billing and coding certification preferred.
3+ years of experience in medical billing strongly preferred.
3+ years of experience in inpatient/outpatient collections with a specialty group practice, with strong emphasis on appeals/underpayment collection activities preferred.
Experience with out-of-network payors.
Comfortable navigating across various computer systems to locate critical information.
Knowledge of insurance policies/guidelines, EOB (Explanation of Benefits), prior authorization/referral processes, medical terminology, CPT/ICD/HCPCS coding preferred.
Experience with payer portals and affiliates.
Experience with EMR and PM systems (Athena, AdvancedMD a plus)
Experience using Salesforce a plus
Must have strong analytical skills, proficient with spreadsheets
Knowledge of health networks, IPA, HMO, PPO and contract affiliations
Proficiency in meeting deadlines and prioritizing workload.
Ability to work independently, with direction, and as part of a team.
Exceptional organizational, presentation, and communication skills, both verbal and written
Experience with Microsoft Office Suite
Self-motivated, team-oriented, very responsible, and focused on exceeding customer expectations.
Working Conditions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms. The employee is required to walk between multiple office locations that include the use of stairs (elevator is only available in some instances).
This position requires the ability to occasionally lift office products and supplies, up to 20 pounds.
Physical Requirements:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee will be required to sit for long periods of time. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms. The employee is required to walk between multiple office locations that include the use of stairs (elevator is only available in some instances).
This position requires the ability to occasionally lift office products and supplies, up to 20 pounds.
TPIRC provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, marital status, veteran status, or any other consideration made unlawful by federal, state, or local laws. TPIRC is committed to providing reasonable accommodation for qualified applicants, and employees with disabilities to ensure they enjoy equal access to all employment opportunities and benefits of employment as required by the Americans with Disabilities Act.
Please note that TPIRC has adopted a mandatory COVID-19 vaccination policy for all employees. We believe this approach to be most effective in ensuring the continued safety of our team and our patients, and congruent with the local and national guidance provided to workers within the healthcare industry. Should you choose to join the organization, you will be required to submit appropriate documentation within the first 45 days of employment. TPIRC will make reasonable accommodations due to disability or religious reasons, as required by law. Temporary deferrals may also be requested (i.e. pregnancy or recent COVID-19 illness).
