Terros Health

  • AR Insurance Specialist

    Job Locations US-AZ-Phoenix
    Job ID
    2018-2752
    # of Openings
    11
    Category
    Billing & Reimbursements
    Program
    Billing & Collections
    Weekly Hours
    40
  • Overview

    Terros Health, Inc. is a four decade old, fully integrated community healthcare provider: With over 30 clinics throughout the Phoenix metro area, including Tucson, Flagstaff and Prescott Arizona. We have an exciting and immediate need for an experienced AR Insurance Specialist. As one of the state’s leading, healthcare providers: Terros Health offers great work-life-balance, and continued career progression. Each new hire is eligible to participate in our best-in-class employee benefit plan the 1st of the month following their date of hire.

    Benefits include:

    • Medical insurance: PPO Health Reimbursement, HDHP Health Savings Account, and a traditional PPO
    • Vision insurance
    • Dental and Orthodontics insurance
    • Flexible Spending Accounts
    • Accidental Death & Dismemberment insurance
    • Disability insurance
    • Paid Life insurance
    • 401K with company matching (Company matching after 6 months of employment)
    • Employee Assistance Program
    • Financial Consultation and Referrals
    • Family & Caregiving Resources and Referrals
    • Legal Consultations
    • Paid Holidays
    • Generous paid time off/Vacation time
    • Paid sick time
    • Tuition discounts through our strategic partnership
    • Employee discounts on car rental through Enterprise Rental Car

    If you've been in search of a growing organization with a forward thinking, and caring culture: Terros Health may be the company you’ve been looking for.

    Responsibilities

    The AR Insurance Specialist will be responsible for review and resolution of outstanding insurance balances on Commercial, Medicare and Medicaid accounts. The AR Insurance Specialist will be required to have d keen analytical skills to evaluate appropriate next steps to bring aged account receivables to resolution. The Insurance Specialist will be responsible to ensure cash recovery goals are met and assigned receivables are appropriately addressed according to company, client and federal guidelines

    • Effectively manages assigned insurance receivables to achieve company set expectations.
      • Exceed productivity standards. as outlined by business line.
      • Exceeds the department standard in work quality scoring and accuracy on all accounts worked.
      • Completes timely follow-up on assigned accounts to ensure no cash loss.
      • Exceeds monthly cash expectations as set out for assigned client receivables.
      • Ensures insurance accounts are resolved within 90 days of placement.
      • Demonstrates the ability to prioritize work with minimal oversight to meet outlined goals.
      • Acts as a knowledge resource for team members.
    • Perform account research.
      • High level understanding of payer system functions.
      • Clearly documents actions taken and next steps for account resolution in Enterprise Practice Management (EPM) system.
      • Demonstrates advanced understanding of commercial, Medicare and Medicaid payers.
      • Has knowledge of Commercial, Medicare and Medicare guidelines and is able to accurately perform corrections according to those guidelines.
      • Demonstrates advanced understanding of claim needs and ability to accurately perform needed billing activities (Evaluation/Correction of billing edits, claim transmission, rejections, and other claim functions).
      • Compiles appeals and approves appeal requests for team related to technical payment denials.
      • Demonstrates the ability to act as request approver for team members to ensure accurate actions are taken for account resolution.
      • Reflects understanding of payer contract verbiage and the ability to negotiate payment utilizing contract terms.
      • Ensure strong communication skills to convey intricate account information.
      • Maintain high quality account handling per client standards.
      • Work within federal, state regulations, department/division & all Compliance Policies.
      • Maintain clear, concise and accurate documentation of all attempts and/or contacts made and received for accounts in accordance with company and client specifications 
      • Maintain continuing education, training in industry career development.
    • Maintain current knowledge of and comply with all federal and state rules and regulations governing phone calls and collections including HIPAA, FDCPA, Privacy Act, FCRA, etc.
      • Attend training sessions as directed by management.
      • Integrate information obtained through training sessions and policy changes immediately into daily routine.
    • Develop professional relationships with internal and external customers, maintain open lines of communication and build rapport by providing timely and professional service.
    • Assists Director in compiling data for Payer claims projects.
    • Works closely with Credentialing Department to troubleshoot payer set up issues which have resulted in unpaid, denied or short pay claims.
    • Process adjustments and/or write offs when appropriate  
    • Monitors, processes and completes follow-up on credit balances. When necessary submits refund requests to management with supporting documentation
    • Contribute ideas for process improvement and special projects as assigned

     

    Qualifications

    • High School Diploma required, prefer an Associate degree in administration or equivalent experience in billing, finance or business administration and at least 2yrs experience.
    • Experience in specific area of work applied for such as healthcare services, customer service and medical records.
    • Worked in a production-based environment before and is a custom to being held to a high standard of productivity
    • Above average skills in Excel and Word. Ability to creates and use Pivot Tables and V-Lookup Functions.
    • Functional knowledge of CMS/HRSA/AHCCCS guidelines
    • Physical demands of this position are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

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