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Accounts Receivable Specialist - Home Health in Albuquerque, NM at Compassus

Date Posted: 1/4/2019

Job Snapshot

Job Description

Current Compassus Colleagues: Please apply via Workday.


The Accounts Receivable Specialist – Home Health is responsible for generating accounts receivable revenue, processing claims, following up on claims, maintaining collection notes, posting deposits, submitting provider notifications, and balancing all aspects of accounts receivable.  This individual also provides backup for accounts payable when AR is involved, which includes working with hospitals and facilities to ensure accurate patient information. S/he is responsible for knowing and applying the rules and regulations of state and federal regulatory agencies and other certified agencies.

Principal Accountabilities

  • Communicates identified needs and potential solutions to supervisor.
  • Notifies DCS of appropriate patient negotiated insurance coverage.
  • Runs pre-billing reports on assigned programs and pre-billing claims for review
  • Monitors as well as assist the programs as needed with financial classes and recertification dates.
  • Generates Patient Revenue.
  • Reviews and transmits/mails claims
  • Is knowledgeable of appropriate data required on claims and assures filing of accurate claims according to payer specifications.
  • Submits appropriate claims corrections or adjustments as needed.
  • Assembles required back up and approvals for AR adjustments and turns them into their Manager.
  • Assembles required back up with Executive Director and Regional Clinical Director approvals for any account balances that will result in bad debt and submits it to the AR Manager for additional approval.
  • Is able to self-organize their work assignments to assure efficiency and effectiveness.
  • Generates unbilled revenue reports at end of month and confirms all patients that were not generated are accounted for.
  • Works the unbilled revenue report weekly by communicating missing information to the programs to ensure generation of all revenue.
  • Maintains copies of required monthly A/R reports.
  • Collects outstanding claims
  • Maintains up-to-date knowledge of Insurance Contracts, and notifies Team Leader or Manager in writing of any problems or deviation from contract.
  • Maintains up-to-date knowledge of Medicare, Medicaid, and Private Insurance rules/procedures/and rates for billing.
  • Monitors every outstanding claim on the aging report at least once every two weeks.
  • Ensures that any account over 60 days old is being investigated on a consistent basis and documents every follow up attempt.
  • Verifies that every related office has received any necessary paperwork in a timely manner.
  • Monitors requests for ADR’s or other information needed to complete billing/collection process on a daily basis and notifies appropriate personnel.
  • Performs monthly status checks on all current ADR patients  
  • Works the RTP claims in Medicare, monitors RA/EOB’s, monitors Medicaid and Private Insurances websites on a daily basis to ensure that all claims are processing for payment.
  • Performs monthly AR reviews and works with Team Leader or Manager to resolve problem accounts.
  • Post Medicare, Medicaid, PIP, or Private Insurance Deposits daily or weekly as needed.
  • Balances EOB/RA’s to deposit entry and bank printouts.
  • Assist with preparation and delivery of items required for program or yearly audits as needed.
  • Other duties as performed or assigned.

Knowledge and Skills

  • Strong written, verbal and interpersonal communications needed. 
  • Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.    
  • Ability to effectively present information and respond to questions from groups of Leaders, and Colleagues.
  • Proficiency in Microsoft Office Suite, software.
  • Ability to work a schedule that meets the organizational needs and project timelines.
  • History of meeting assignment deadlines and budgetary requirements.
  • Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. 
  • Ability to deal with problems involving several concrete variables in standardized situations. 
  • Ability to identify anomalies within current data as well as across history.
  • Ability to compute rate, ratio, and percentages.
  • Experience in accounting information systems is required.

Education and/or Experience

High School diploma or GED required. Associate's degree or equivalent from two-year college or technical school preferred; minimum of one year experience in healthcare billing systems and/or training in data processing on micro-computer systems and third party billing in a health care setting.

Other Qualifications

Possesses familiarity with medical terminology and medical records.  Possesses effective communication and organizational skills. Maintains a professional demeanor and appearance and is self-motivated and dependable. High integrity, including maintenance of confidential information, such as patient records.

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