Multi-site Dermatology Group Seeks Accounts Receivable Specialist

Optima Dermatology is recruiting an Accounts Receivable Specialist team, based in Portsmouth, NH. Remote and hybrid opportunities available for residents of FL, IN, MA, ME, NC, NH, OH, PA, VA, WA.

At Optima Dermatology, our mission to revolutionize skin care is made possible by our world class team that is highly engaged, mission-driven, and inspired to set the new standard in dermatology. We are growing rapidly and looking for key team members who believe in our mission and want to make a difference in the lives of our patients. We foster a collaborative environment that is fun and hardworking and promise you will work alongside amazing colleagues you are proud to call your teammates.

POSITION SUMMARY:

Reporting directly to the AR and Posting Manager, the Accounts Receivable Specialist is responsible for all work associated with resolving aging claims in Accounts Receivable for assigned URL’s, payers, or claims. Also responsible for working denials and secondary claims when electronic secondary processing is not available and working closely with posting staff to identify issues with posting which affect claims status on the AR. Remote and hybrid opportunities available.

PRIMARY RESPONSIBILITIES:

• Reviews and works rejected claims to ensure rejection accuracy and meets deadlines
• Daily follow up on all assigned outstanding insurance payers, URLs, and associated claims
• Verify and update accounts to resolve balances and ensure the proper payer and responsible party are identified and linked to assigned claims worked
• Research and validate posted payments and adjustments to ensure claims processed and posted as expected and make corrections as needed to resolve balances and leave accounts in a zero-balance state, including working overpaid and credit accounts and applying refunds as needed
• Post EOB’s, payments, and adjustments on an ad hoc basis as needed to resolve outstanding claims found on assigned URL’s, payers, or claims
• Review and process correspondence received to resolve open A/R balances for assigned URL’s, payers, and claims
• Review denials and underpayments for appeal and/or resolution
• Work with supervisor(s) to streamline billing procedures based on denial and payment delay trends
• Provide best billing practices and payor trends to other revenue cycle areas to improve revenue cycle operations
• Manage incoming calls from insurance companies regarding claims and requests for additional documentation to process submitted claims
• Maintains correspondence with payers regarding unresolved balances and keeps a related log of interactions and issues identified
• Collaborates with EDI team when systemic claims submission issues are identified
• Collaborates with the Cash posting team to ensure that aging receivables paid or adjudicated but not posted are remediated promptly and root cause identified and corrected
• Understands and interprets insurance Explanations of Benefits (EOBs)
• Resubmits claim forms as appropriate
• Professionally responds to inquiries related to aging receivables from staff and payers in a timely manner
• Accurately documents patient accounts of all actions taken
• Apprises management of concerns as appropriate
• Informs management, as appropriate, regarding backlogs and time available for additional tasks
• Utilize resources such as provider portal(s), websites, provider relations teams and telephone to research, escalate and resolve any issues with claim processing and/or rejections
• Secondary claim files updated with primary EOB information as needed
• Function as a resource to answer questions promptly and accurately including, but not limited to, questions from other team members, management, and payors
• Maintain set standards, metrics and KPIs and ensure individual and departmental goals are met
• Participate in revenue cycle projects as needed
• Maintains working day to day knowledge of the practice management system

POSITION REQUIREMENTS:

• High School diploma or equivalent
• Minimum one (1) year of medical billing background and a consistent record of entering demographics and insurances
• Capable of adapting to multiple applications of software
• Skill in exercising initiative, judgment, discretion, and decision-making to achieve business unit objectives
• Knowledge of reimbursement processes, billing, and accounts receivable
• Knowledge of CPT and ICD-10 coding
• Knowledge of payer billing guidelines and policies
• Ability to work independently and as part of a team
• As necessary, negotiates a work improvement plan with management to raise work quality and quantity to standards
• Demonstrate excellent written and verbal skills, professional etiquette and courtesy when working with both internal and external customers