JOB PURPOSE: The AR Specialist I position is responsible to obtain medical eligibility information ensuring that the most updated insurance is entered into the practice management system, obtain authorizations, and assist patients with their account inquiries, routing and advancing calls as needed. 

JOB FUNCTIONS:

• Research eligibility information with various insurance carriers. 
• Responsible for obtaining or validating referrals and authorizations for procedures and services, as required
• Responsible for ensuring billed charges are allowable per payer policies.
• Accurate verification of all insurance benefits, and entry of new or updated insurance information for all patient accounts
• Responsible for outreach to patients or payers to validate incomplete insurance information
• Assist with customer service calls
• Retrieve supporting documentation and other data from all facilities for accurate and timely processing of claims 
• Manage the worklist assignment for eligibility holds within practice management system
• Manage collection assignment worklists in the practice management system.
• Participate in internal audit requests
• Possess understanding of EOB nomenclature
• Open, process, and distribute inbound correspondence 
• Meet department standards for production and quality
• Assist in the development and ongoing assessment of policies and procedures
• Identify and communicate problems to team members and management
• Attend monthly meetings to keep abreast of policy changes and billing department concerns
• Other duties as assigned

Education:

• High school diploma or equivalent

Experience:

• Minimum one (1) to two (2) years experience using a computerized accounts receivable system in a medical or hospital setting performing billing functions.
• Minimum one (1) year of experience utilizing insurance payer portals
• Experience in handling confidential data, patient demographic information

PERFORMANCE REQUIREMENTS:

Knowledge:

• Knowledge of medical insurance and authorization processes
• Maintain up to date knowledge of insurance policies
• Ability to pass Billing Department testing at 70%.
• Basic Microsoft Excel and Word knowledge
• Basic CPT-4 and ICD-10 coding knowledge preferred.

Special Skills:

• Analytical with attention to detail
• Excellent customer service skills
• Excellent organization and time management skills
• Strong verbal and written communication
• Bilingual preferred

Abilities:

• Ability to remain focused and productive as tasks may be repetitive 
• Ability to effectively work and communicate with coworkers, patients, and outside agencies
• Ability to prioritize and manage multiple tasks
• Ability to work effectively in a fast, team-based environment 

Equipment Operated:

• Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.

Work Environment:

• Position in a well-lit, well-ventilated office environment. Frequent contact with a variety of people.

Physical Requirements:

• Involves sitting approximately 90 percent of the day, walking or standing the remainder. Some bending, stooping, and lifting up to 15 pounds.

Safety:

• All employees are responsible for complying with safe and healthy work practices as outlined in Inspire Health’s Employee Safety and Injury and Illness Prevention Program and policies and procedures specific to their department needs.