To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values-integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
Pre AR Accounts Receivable Analyst- Appeals handles a high volume of third
party claims that have been denied for lack of authorization or referral, as
well as medical necessity and ensures that accurate information is submitted to
payers via the clearing house and/or payer intermediary in a timely manner to
ensure prompt reconsideration of payment via corrected claims or the payers
appeal process as it related to the medical necessity of the patient\u2019s
Pre AR ARA initiates the actions necessary to correct problems that prevent
claims processing and /or contacts the individuals that are responsible
for taking the corrective action to expedite claims processing. Documents all
follow up activities on accounts in a clear and concise manner. Identifies and
reports the trends of claim denials and rejections to the supervisor for
further review. Performs a variety of duties necessary to collaborate with
practice staff as well as CPBS Education Outreach for process improvement.
Keeps abreast of the changes to federal, state, and insurance regulations as
well as maintains a general knowledge of billing, payment
methodologies/guidelines, and payer medical necessity policies. Has an
understanding of the Professional Billing Revenue Cycle and how it functions.
Performs all other duties as requested by supervisor.
High school diploma or GED required. Associate Degree in business related field preferred.
Minimum of one (1) to two (2) years'' experience in healthcare revenue cycle with third party claims management and/or billing required.
Extensive knowledge of third party insurance carriers and their billing and reimbursement requirements. Excellent analytical and organizational skills. Demonstrated ability to perform detailed analysis quickly and accurately in a high volume, fast paced environment. Ability to communicate effectively both written and verbally. Microsoft Office skills preferred. Proven ability to effectively navigate various payer websites and other web based applications.
Responsible for the retrospective review of the payment of claims to ensure maximum reimbursement. Reviews remittance data to ensure that assigned claims reflect accurate information and have been submitted to payers through appropriate intermediary. Responsible for reporting identified credit balances when appropriate. Must develop and maintain effective relationships with payer representatives to ensure accurate reimbursement according to a variety of contracts. Supports departmental goals and objectives by meeting or exceeding best practice standards. Ability to exercise sound judgment and act with discretion in a variety of situations as well as ensuring and maintaining sensitive information in a confidential manner, in accordance with HIPAA guidelines.
Highly organized individual with the ability to analyze data, problems, and exercise sound judgment. Uses sound and thoughtful problem solving skills to resolve account discrepancies and ensures timely collection of balances. Capable of using analytical skills and resourcefulness to accomplish many tasks and balances multiple priorities in a fast paced environment. Ability to interact professionally (through written or verbal communication) with other departments, third party payers, and other agencies to resolve complex issues related to maximizing reimbursement.