Walk-in || Revenue Integrity AR Specialist

Job Summary

• The Revenue Integrity AR Specialist analyzes payer payment variances across the organizations three core business units: Radiology, Anesthesia, and Emergency/Hospital Medicine. This role identifies and removes false positives from inventory and resolves underpayments for clients in accordance with each client’s specific payer contracts.

Essential Functions and Tasks

• Identify and resolve contract variances by distinguishing false variances from those requiring action, including collaborating with internal departments, working directly with payers, and reviewing contract language and rates.
• Submit project appeals – preferably in bulk - related to contract performance variances across all specialties.
• Prepare and submit underpayment appeals using established guidelines and accurately document patient accounts in source systems.
• Process and follow up on appeals, including inbound and outbound calls as needed.
• Communicate with insurance companies regarding the status of outstanding appeals.
• Meet established production and quality standards set by Ventra Health.
• Perform special projects and other duties as assigned.

Education and Experience Requirements

• High School Diploma or GED. College education is preferred.
• At least three (3) years of experience in medical billing specifically resolving Accounts Receivable, contacting insurance carriers, using payer portals, completing appeals, identifying and communicating trends.
• Experience with offshore engagement and collaboration desired.

Knowledge, Skills, and Abilities

• Knowledge of State, Federal, and Managed Care regulatory guidelines
• Knowledge of benefit insurance billing and contract management 
• Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills.
• Strong oral, written, and interpersonal communication skills 
• Strong decision-making skills 
• Strong problem-solving skills 
• Strong time management skills 
• Basic word processing, spreadsheet, database, and presentation software skills 
• Basic mathematical skills in addition, subtraction, multiplication and division of whole numbers and fractions; computing percentages; and working with decimals 
• Ability to read, understand, and apply state/federal laws, regulations, and policies 
• Ability to exercise sound judgment and handle highly sensitive and confidential information appropriately 
• Ability to remain flexible and work within a collaborative and fast paced environment
• Ability to communicate with diverse personalities in a tactful, mature, and professional manner
• Become proficient in the use of billing software within 4 weeks and maintain proficiency.
• Understand and comply with company policies and procedures.