SUMMARY: This position is responsible for the daily processing and review of claims to insurance companies in support of the Revenue Cycle department. As an Accounts Receivable Specialist you will also be responsible for timely follow-up on claims and communicating and working with payer(s) and patients to resolve their accounts. In this position you will be primarily responsible for the timely collection and follow up of Medicare Advantage claims as assigned. In addition, this position will support the communications department as needed with insurance verification, and pre-certification support as needed.

NOTE: While this is a remote (Work From Home) position, you must be a Texas resident.

ESSENTIAL DUTIES AND RESPONSIBILITIES: (Responsibilities include, but not limited to)

• Responsible for reviewing and resolving all outstanding balances in the accounts receivable as it pertains to Medicare Advantage claims.
• Reviews the activity on accounts, determining the best course of action to attain payment of outstanding balances, which may include claim corrections, and appeals.
• Process claims and denials per CMS guidelines.
• Responsible for incoming/outgoing phone calls to/from patients and/or insurance agencies in a courteous and professional manner and appropriately addressing their questions or concerns. Also responsible for documenting the conversation on ALL contacts.
• Review and work existing Accounts Receivable activity based on the direction of the Billing Director.
• Process and work claim correspondence from assigned payor category.
• Verify insurance and support the communications department on payor requirements for pre-arranged transports.
• Communicate as required with facilities regarding the authorization requirements on pre-arranged transports
• Adhere to company policies and procedures.
• Other duties as assigned.

• KNOWLEDGE AND SKILLS:

• Attention to detail.
• Possesses intermediate knowledge of Medicare, Medicaid and insurance benefits.
• Knowledge of computer and office equipment.
• Ability to maintain records and files.
• Outstanding communication skills.
• Continuous focus on quality.
• Experienced professional with outstanding time management skills.

PHYSICAL REQUIREMENTS:

• Full time remote position (Texas residency required)

• Minimum 2 years of experience performing medical billing, medical coding, verification or accounts receivable management.

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.

Allegiance is an EEO employer as defined by the EEOC.