Accounts Receivable Specialist - Medical Appeals and Denials
Atlanta, GA | Billing
GoHealth Urgent Care partners with healthcare systems across the country to provide unparalleled experiences for our customers, employees, partners and community. We live our values of innovation, collaboration, diversity/inclusion, courage/integrity and accountability. We believe in promoting from within and the value of each team member. Check us out as we are growing and in need of professionals whose mission and values coincide with GoHealth!
The Accounts Receivable Specialist is a goal-oriented, revenue-driven, highly accurate and motivated professional. Primary duties include, but are not limited to: consistently follow up on unpaid claims utilizing monthly aging reports, filing appeals when appropriate to obtain maximum reimbursement and establish and maintain strong relationships with providers, clients, patients and fellow staff. Secondary duties include but are not limited to: data entry of all patient demographic, guarantor and insurance information, posting procedures and insurance/patient payments, balance to daily deposits.
- High School Diploma or GED required
- Associate’s degree in Healthcare Management/Health information Management or related field preferred
- 1+ years' working professional, physician appeals and denials, accounts receivable experience in a mid to large organization - required
- 2 years working denials and appeals in medical environment other than professional/provider. For example - hospital, behavioral health, home health accounts receivable experience required
- CPAR – Certified Patient Account Representative preferred
- Certified Medical Billing Specialist preferred
Additional Knowledge, Skills and Abilities Required
- Hands on knowledge of CPT and ICD codes
- Excellent phone, communication, organizational skills, computer skills and mathematical skills
- Ability to maintain patient confidentiality
- Collaboration: Supports others and partners to work as a team. Actively listens, seeks feedback and checks for understanding. Is a servant leader to our customers, team members, partners and communities. Doesn't assume to always have the right answer. Creates shared success by leveraging the strengths of the entire team.
- Innovation: Embraces new ideas, processes and tools, challenges the status quo, solve problems creatively, strives for continuous improvement. Tests, assesses, adjusts, and learns.
- Diversity and Inclusion: Assumes positive intent. Recognizes, values and celebrates differences. Respects, connects with and learns from each other. Actively engages others’ strengths and talents, especially when they are different. Acts, thinks, and listens without bias or prejudice.
- Courage & Integrity: Does the right thing, especially when it is difficult. Commits to organizational transparency. Promotes the truth, even when it is unpopular or controversial. Is ethical, fair and authentic. Shares new ideas with conviction.
- Accountability: Always shows initiative, demonstrates a bias to action and gets things done on time. Actively accepts responsibility for diverse roles, obligations and actions that positively influence patient and customer outcomes, our partnerships and the healthcare needs of our communities. Is specific, objective, and actionable.
Customer service skills:
- Ability to represent the Department in a professional manner when interacting with patients, guests,
- physicians and their staff
- Ability to handle service issues professionally• Ability to follow through with customers
- Ability to communicate effectively to patients about their medical conditions and the financial aspects of their care.
- Ability to manage time and balance priorities
- Organizational skills
- Ability to type proficiently
- Ability to function effectively as extension of the Center
- Be flexible and open-minded in thought processes
- Maintain focus under pressure
- Share relevant information with other team members
- Volunteer to assist others when time permits
- Ability to work collaboratively to identify and help resolve enterprise-wide challenges
Medical Terminology & Insurance
- Knowledge of insurance guidelines for different states including Medicare, state Medicaid and workers comp.
- Knowledge of basic medical terminology
- Ability to calculate deductible and co-insurance correctly
- Ability to read and understand carrier Explanation of Benefits
Additional Knowledge, Skills, and Abilities Preferred
- Epic or eClinicalWorks experience
- Experience with Microsoft Excel and Word
- Communicate daily with Team Leaders/Section Leaders
- Provide excellent customer service in all interactions, such as when working with Patient Account Specialists, patients, payors and center staff
- Work each account to its conclusion, including but not limited to reviewing and following up payment denials, contacting insurance carriers for payment resolution, filing appeals, submitting insurance claims to clearing house or individual insurance companies, retracting clams, and processing write offs and adjustments for non-payable charges accroding to payer contract.
- Enter information necessary for insurance claims such as patient, insurance ID, diagnosis and treatment codes and modifiers, and provider information. Insure claim information is complete and accurate.
- Prepare appeal letters to insurance carrier when not in agreement with claim denial. Collect necessary information to accompany appeal.
- Check insurance payments for accuracy and compliance with contract discount
- Post insurance and patient payments using medical claim billing software.
- For patients with coverage by more than one insurer, prepare and submit secondary claims upon processing by primary insurer. Respond to inquiries from insurance companies, patients and providers Verify patient benefits eligibility and coverage.
- Assist the Customer Service team in taking patient phone calls..
- Follows HIPAA guidelines in handling patient information.
All other duties as assigned.
Note: this job description is not inclusive of all the duties of the position. You may be asked by leaders to perform other duties. Management reserves the right to revise this position description at any time.
All qualified persons are granted an equal opportunity for employment without regard to race, color, religion, sex, sexual orientation and gender identity or expression, age, national origin, citizenship status, disability, genetic information, medical condition, family care leave status, pregnancy or pregnancy-related condition, otherwise qualified disabled or veteran status. The company will comply with all fair employment laws in each of the jurisdictions where we conduct business.
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GoHealth Urgent Care has outstanding career opportunities in Connecticut, Delaware, Missouri, New York City, North Carolina, Northwest Arkansas, Oklahoma City, San Francisco and the Portland-Vancouver area. And all of these positions have one thing in common: flexibility to practice urgent care medicine the way it was meant to be, without the stress and bureaucracy of hierarchical organizations. With reasonable work hours that don’t emotionally exhaust them or burn them out, our team can balance and prioritize their professional and personal lives.
The lifestyle you can lead.
Atlanta is Georgia’s state capital and home to approximately half a million residents. Well known for its arts, theater, galleries and museums, cultural attractions, and institutions of higher education, Atlanta offers many things to do. Visit Georgia Aquarium, the largest public aquarium in the Western Hemisphere. Shop and enjoy great entertainment in Underground Atlanta. See wildlife shows at Zoo Atlanta. Catch a pro football, basketball or baseball game. Foodies will delight in local favorites, such as crab fritters, chicken biscuits, pulled pork sandwiches and salted caramel ice cream. Choose from many welcoming neighborhoods to live in, from downtown and midtown to Chastain Park, and from Buckhead to Cabbagetown, Kirkwood and Morningside. There’s also a good selection of public and private schools and nearby colleges and universities. Public transportation is excellent, and Atlanta is also served by Amtrak and Hartsfield-Jackson Atlanta International Airport.