Accounts Receivable Specialist (SMG West)
Steward Health Care System LLC ("Steward") is a fully integrated, physician-led national health care services organization committed to providing the highest quality of care in the most cost-efficient manner in the communities where out patents live. Steward - the largest privately held health care company in the U.S. - owns and operations 35 community hospitals across nine states, serves over 1,000 distinct communities and employs approximately 40,000 health care professionals. In addition to our hospitals, the Steward provider network includes 4,800 providers, 25 urgent care centers, 87 preferred skilled nursing facilities, substantial behavioral health offerings, over 7,300 hospital beds under management, and approximately 1.5 million full risk covered lies through the company's managed care and health insurance services. The total number of paneled lives within Steward's integrated care network is projected to reach 3 million in 2018.
Steward Medical Group (SMG), Inc. is Steward's multi-specialty group practice with over 4,500 employees including over 1,800 physicians and advanced practitioners. SMG operates approximately 450 practice locations throughout Massachusetts, Southern New Hampshire, Rhode Island, New Jersey, Pennsylvania, Ohio, Florida, Utah, Arizona, Texas, Louisiana and Arkansas, and provides more than 4 million patient encounters per year.
This position is responsible for timely follow-up of assigned claims that have been rejected or denied. Effective analysis and resolution of accounts receivable are based on third-party claim processing guidelines and established policies and procedures. The Accounts Receivable Specialist reports to the AR Manager.
- Works all reports related to outstanding claims, such as worklists, hold reports, and rejection reports to ensure claims are corrected and submitted/resubmitted timely and accurately, per payer guidelines and Steward Medical Group policies;
- Appropriately analyzes denials and scrubs for root causes, and takes necessary steps to resolve;
- Identifies issues and trends, and effectively communicates related data to leadership for assessment of potential systems or workflow improvement;
- Accesses and completes any documentation necessary for timely billing/rebilling of patient claims, including requesting or retrieving medical records and other attachments to ensure the payer’s acceptance of the claims;
- Processes and files claims for secondary billing, attaching all required documentation to ensure claims are reimbursable by applicable payers;
- Understands and complies with all payer guidelines related to claim submission; is knowledgeable and proficient with payer websites and other useful resources pertaining to the billing function;
- Focuses daily on complying with policies, procedures, and department guidelines for billing and claim edit resolution; and
- Maintains strict confidentiality and adheres to all HIPAA guidelines/regulations.
- Associate’s Degree is required
- At least two years’ related experience
- Knowledge of basic medical coding/terminology and third-party insurance operating procedures and practices a plus
- Knowledge of revenue cycle and/or business office procedures
- Highly detail-oriented and well-organized
- Ability to read, understand, and follow oral and written instructions
- Ability to establish and maintain effective working relationships and communicate clearly with customers and insurance companies both within and outside of Steward Health System
- Medical billing and coding certification a plus
- Experience with medical billing software –athenaNet preferred
- Paid time off
- Health/Dental/Vision insurance
- Healthcare spending or reimbursement accounts such as HSAs or FSAs
- Employee Assistance Program
- Tuition Reimbursement
- And much more…
Job Status: Full Time
Job Reference #: 11985