Position Title:
Accounts Receivable Specialist
Working Title:
Accounts Receivable Specialist
Reports To:
Practice Administrator
JOB SUMMARY: Responsible for all facets of medical billing and accounts receivable
management including charge entry, payment posting, customer service and follow-up in
accordance with practice protocol with an emphasis on maximizing patient satisfaction and
profitability. Responsible for reviewing the patient demographic information in the MegaWest
practice management system at the time of charge entry to ensure accuracy and to provide
feedback to the other front office staff regarding patient registration. Responsible for reviewing
the physician’s coding at the time of charge entry to ensure accuracy, timely payments, and to
maximize revenue. Responsible for submitting insurance claims both electronically once per day
and on paper semi-weekly. Responsible for providing cross coverage for the Authorization
Coordinator, Receptionists as required to ensure efficient and professional practice operations
and maximum patient satisfaction.
SPECIAL CHARACTERISTICS: This position requires a comprehensive understanding of
accounts receivable management in a healthcare setting. This position requires strong working
knowledge of managed care plans, insurance carriers, referrals and precertification procedures.
Also required is a strong working knowledge of CPT, ICD-9, HCPCS, modifiers, coding and
documentation guidelines. Strong customer service, organizational and communication skills are
essential to this position. In addition, strict adherence to write-off policies, refund policies and
other accounts receivable policies as outlined in the Procedure Manual is required. This position
requires an ability to prioritize multiple tasks simultaneously in an occasionally stressful
environment. Also required are general computer skills, typing skills and a working knowledge
of Medicare Compliance, OSHA and HIPAA.
ESSENTIAL FUNCTIONS:
1. Input all charges related to the assigned physician’s professional services into the
practice management system including office and hospital charges in accordance with
practice protocol with an emphasis on accuracy to ensure timely reimbursement and
maximum patient satisfaction. All charge batches should balance in both number of
procedures and total dollar prior to posting.
2. Post all payments, by line-item, received for physician’s professional services into the
practice management system including co-payments, insurance payments, and patient
payments in accordance with practice protocol with an emphasis on accuracy to ensure
maximum patient satisfaction and profitability. All payment batches must be balanced in
both their dollar value of payments and adjustments prior to posting.
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3. Post all credit and debit adjustments to patient accounts with strict adherence to the
guidelines in the Procedure Manual.
4. File all charge, payment and adjustment batches in the appropriate format by batch date
for quick reference.
5. Review the physician’s coding at charge entry to ensure compliance with Medicare
guidelines and to ensure accurate and timely reimbursement.
6. Provide customer service both on the telephone and in the office for all patients and
authorized representatives regarding patient accounts in accordance with practice
protocol. Patient calls regarding accounts receivable should be returned within 2 business
days to ensure maximum patient satisfaction.
7. Verify all demographic and insurance information in patient registration of the practice
management system at the time of charge entry to ensure accuracy, provide feedback to
other front office staff members and to ensure timely reimbursement.
8. Follow-up on all outstanding insurance claims at 60-days from the date of service in
accordance with practice protocol with an emphasis on maximizing patient satisfaction
and practice profitability.
9. Follow-up on all outstanding patient account balances at 90-days from the date of service
in accordance with practice protocol with an emphasis on maximizing patient satisfaction
and practice profitability using the A/R aged reports.
10. Provide information pertaining to billing, coding, managed care networks, insurance
carriers and reimbursement to physicians, managers and subordinates.
11. Follow-up on all returned claims, correspondence, denials, account reconciliations and
rebills within five working days of receipt to achieve maximum reimbursement in a
timely manner with an emphasis on patient satisfaction.
12. Submit primary and secondary insurance claims electronically each day and on HCFA
semi-weekly to ensure timely reimbursement.
13. Attendance at relevant seminars to remain abreast of current issues regarding obstetric
and/or gynecology accounts receivable, Medicare Compliance and HIPAA.
14. Recommend accounts for outside collection when internal collection efforts fail in
accordance with practice protocol.
15. Process refunds to insurance companies and patients in accordance with practice
protocol.
16. Reconcile the incoming lockbox deposits in accordance with practice protocol as required
to ensure timely payment posting.
17. Monitor reimbursement from managed care networks and insurance carriers to ensure
reimbursement consistent with contract rates.
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18. Monitor the supply and quality of forms, envelopes and supplies as required to perform
job functions.
19. Proficiency with all facets of the medical practice management system including patient
registration, charge entry, insurance processing, advanced collections, reports and ledger
inquiry.
20. Provide cross coverage for the switchboard operator as required to ensure efficient and
professional practice operation including lunch and break coverage.
21. Proficiency with WebMD, a web-based program for eligibility verification and claim
status, to efficiently conduct accounts receivable follow-up and to maximize revenue.
22. Maintain information regarding coding, insurance carriers, managed care networks and
credentialing in an organized easy to reference format.
23. Maintain an organized, efficient and professional work environment.
24. Adhere to all practice policies related to OSHA, HIPAA and Medicare Compliance.
25. Other duties as assigned.
SUPERVISES: This position has no supervisory responsibilities.
EDUCATION: High school diploma or GED is required. A college degree is preferred.
EXPERIENCE: Requires a minimum of 3 years of accounts receivable experience preferably
in an obstetrics and/or gynecology setting.
SKILLS:
1. The jobholder must demonstrate current competencies applicable to the job position.
2. Requires excellent written and verbal communication skills and strong customer service
skills.
3. Requires strong basic mathematical skills.
4. Requires a minimum typing speed of forty (40) words per minute and ten-key by touch.
5. Requires an extensive working knowledge of managed care networks and insurance
carriers.
6. Requires an extensive working knowledge of accounts receivable functions including
CPT and ICD-9 coding.
7. Requires proficiency in general office automation including operation of fax machines,
copy machines, adding machines, postage machines, and multi-line phone systems.
8. Requires proficiency in working with a PC, the Internet, and MS Windows.
9. Requires a good understanding of the current Medicare Compliance, OSHA, and HIPAA
regulations.
10. Requires a high degree of organization.
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ABILITIES:
1. Ability to establish/maintain cooperative working relationships with staff and providers.
2. Ability to communicate effectively and in a professional manner with patients using
interpersonal skills.
3. Ability to communicate effectively and in a professional manner with all staff, managers
and physicians.
4. Ability to prioritize and multi-task.
PHYSICAL/MENTAL DEMANDS:
1. Combination of sitting, standing, bending, light lifting and walking.
2. Requires a full range of body motion including manual and finger dexterity and hand-eye
coordination.
3. Requires corrected vision and hearing to a normal range.
4. Requires the ability to manage stressful situations.
5. Occasional stress from varying demands.
OTHER REQUIREMENTS:
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Restriction of personal phone calls to break and lunch periods.
Overtime as authorized by supervisor.
Attendance at monthly front office staff meeting.
Attendance at monthly all staff meeting.
Attendance at training sessions.
Adherence to the front office uniform policy.
Adherence to practice policies, procedures and protocol.
This description is intended to provide basic guidelines for meeting job requirements.
Responsibilities, knowledge, skills, and working conditions may change as needs evolve.
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