Job Detail

**THIS IS NOT A FULLY REMOTE POSITION**

AR Representative will ensure the timely receipt of claim payments and minimizes bad debt accrual. AR Representative will also be responsible for keeping up with department and billing standards. This position is responsible for processing a variety of payers such as Medi-Cal, CHDP, Medicare, HMO’s, and private insurances. Additional duties include follow-up on unpaid claims within 30 days of claim submission.

Functions and Responsibilities:

• Conduct collection calls and/or correspondence in a fast-paced goal-oriented collections department.
• Manage claims collections (not patient collections)
• Provide customer service regarding collection issues (as applicable according to client contracts)
• Ability to differentiate the difference between in and out of network
• Resolve insurance discrepancies and short payments
• Contact and inquire with insurance companies for collection
• Identify issues or trending and provide suggestions for resolution.
• Review the account information and necessary system applications to determine the next appropriate work activity. Accurately and thoroughly documents the pertinent collection activity performed
• Perform appropriate billing functions, including manual re-bills as well as electronic submission to payers. Edit claims to meet and satisfy billing compliance guidelines for electronic submission. Manage and maintain desk inventory, complete reports, and resolve high priority and aged inventory
• Document in detail problem/action/ and follow up with insurance companies until claim paid
• Possess working knowledge of Explanation of Benefits (EOB’s)
• Responsible for monitoring and maintaining assigned accounts
• Accountable for reducing delinquency for assigned accounts
• Verification of Refund Requests and Medical Records requests
• Initiate and resolve Appeals for many different insurance payers
• Respond timely to emails and telephone messages as appropriate. Communicate issues to management, including payer, system or escalated account issues
• Perform additional duties as requested by Supervisor or Management team

Qualifications and Key Competencies:

1. Organizational Skills: Candidate must be detailed oriented and have good analytical and organization skills. Candidate must have the ability to work in a fast-paced environment.

2. Primary Role: The primary role of Accounts Receivable Representative is to oversee and manage insurance denials including all aspects of follow up and collections. Excellent time management skills are a must.

3. Certifications and Experience: Certified Medical Billing Specialist Certificate (CMBS), or similar certification, preferred. Minimum 5 years of medical billing and/or insurance collections experience required.

4. Problem-Solving Skills: Candidate must possess abilities to problem solve, prioritize, and follow-through completely with assigned tasks. Candidate must possess analytical skills to examine billing information for accuracy and completeness.

5. Software Experience: Competency in Practice Management systems, Clearinghouse systems, and demonstrated accuracy in claim processing (less than 2% error rate) is required. Candidate must demonstrate ability to report our daily claim trends, identify and report out process interruptions, and be competent in peer-to-peer communication.

6. Communication: This position may be responsible for autonomously communicating with clients and candidate must demonstrate ability to professionally and independently communicate appropriately (both verbally and in writing).

Essential Duties and Responsibilities:

1. Responsible for the following insurance carriers, including but not limited to:

a. Commercial FFS, CHDP, CDP

b. All Managed Care entities including LA Care, Cal Optima, IEHP etc.

c. Medicare, Medi-Cal

d. WPS/TRICARE

e. Champ VA

f. Trailblazers, Railroad Medicare

2. Reviewing aged insurance report

a. Works aged insurance AR

3. Working rejections/denials

4. Answering patient phone calls

5. Other assignments as directed by billing supervisor.

6. Adhere to highest standards of professionalism and compassion in providing billing assistance to all Medcor client patients

7. Regular and reliable attendance

8. Maintain Fraud and Abuse, HIPAA and PHI compliance requirements

9. Participate in daily team huddles and other meetings, as applicable

10. Other duties as assigned

Knowledge:

1. Knowledge of healthcare revenue cycle

2. Knowledge of CPT and ICD-9/10 coding

3. Knowledge of insurance companies and their rules and allowables

4. Knowledge of medical, insurance collections and insurance terminology

5. Knowledge of HIPAA and other applicable state/federal requirements

6. Knowledge of applicable state collection laws

Technology skills:

1. Basic computer skills including Word and Excel

2. Internet navigation

3. EMR/EHR software experience

Physical demands

1. Sitting for long periods of time.

2. Move quickly when client or patient needs assistance

3. Using keyboard

4. Using telephone receiver

Working Conditions

1. Involves frequent telephone calls with patients. Line must be clear of personal business so patients can get through.

2. Work may be stressful at times. Interaction with others is constant and interruptive.

3. Well lit, ventilated work space.

Equal Employment Opportunity

The MEDCOR Group, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Job Type: Full-time

Pay: $21.00 - $27.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Work setting:

• Hybrid remote

Ability to commute/relocate:

• Orange, CA 92868: Reliably commute or planning to relocate before starting work (Required)

Experience:

• eClinicalWorks: 1 year (Preferred)
• Epic: 1 year (Preferred)
• Medical billing: 1 year (Required)
• Medical AR: 1 year (Required)

Work Location: Hybrid remote in Orange, CA 92868