Overview: We are seeking an experienced and detail-oriented Accounts Receivable Specialist to join our central billing office team for ambulatory surgery centers. The successful candidate will play a crucial role in resolving outstanding surgical claims resulting in maximum reimbursement.

Responsibilities:

• Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers including self-pay to obtain maximum reimbursement.
• Prioritize high dollar claim balances through work queues
• Review & work incoming insurance and patient correspondence including refund requests.
• Send appeals when appropriate or provide the requested medical documentation.
• Ability to review medical documentation to justify medical necessity.
• Review patient balances to ensure accuracy and follow up with patients to obtain payments.
• Take incoming patient phone calls to resolve inquiries, billing issues, or outstanding balances.
• Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents.
• Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD’s) for claim resolution.
• Negotiate payment amounts for procedures with Third Party Administrators for out of network providers.
• Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.

• 2+ years of ASC revenue cycle OR orthopedic collections experience is preferred.
• Strong understanding of medical billing and insurance reimbursement processes, including experience with denials and appeals.
• Ability to read and interpret insurance explanations of benefits and managed care contracts.
• Excellent interpersonal and communication skills.
• Must be able to multi-task and handle competing priorities while meeting or exceeding deadlines.
• Intermediate computer proficiency in Microsoft Office including Excel and Outlook.
• Advantx, Vision, HST, SIS Complete, or Waystar experience preferred.
• High School Diploma or equivalent is required.