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Accounts Receivable Specialist (SMG West)

Company: Steward Health Care System
Location: Franklin
Posted on: February 13, 2020

Job Description:

About Steward Health Care SystemSteward Health Care is the largest private, tax-paying physician-led health care network in the United States. Headquartered in Dallas, Texas, Steward operates 35 hospitals in the United States and the country of Malta that regularly receive top awards for quality and safety. The company employs approximately 42,000 health care professionals. The Steward network includes multiple urgent care centers and skilled nursing facilities, substantial behavioral health services, over 7,900 beds under management, and approximately 2.2 million full risk covered lives through the company's managed care and health insurance services.Steward Medical Group (SMG), Inc. is Steward's multi-specialty group practice with over 4,500 employees including over 1,800 physicians and advanced practitioners. SMG operates approximately 450 practice locations throughout Massachusetts, Southern New Hampshire, Rhode Island, New Jersey, Pennsylvania, Ohio, Florida, Utah, Arizona, Texas, Louisiana and Arkansas, and provides more than 4 million patient encounters per year. Position Summary: This position is responsible for timely follow-up of assigned claims that have been rejected or denied. Effective analysis and resolution of accounts receivable are based on third-party claim processing guidelines and established policies and procedures. The Accounts Receivable Specialist reports to the AR Manager.Key Responsibilities:

  • Works all reports related to outstanding claims, such as worklists, hold reports, and rejection reports to ensure claims are corrected and submitted/resubmitted timely and accurately, per payer guidelines and Steward Medical Group policies;
  • Appropriately analyzes denials and scrubs for root causes, and takes necessary steps to resolve;
  • Identifies issues and trends, and effectively communicates related data to leadership for assessment of potential systems or workflow improvement;
  • Accesses and completes any documentation necessary for timely billing/rebilling of patient claims, including requesting or retrieving medical records and other attachments to ensure the payers acceptance of the claims;
  • Processes and files claims for secondary billing, attaching all required documentation to ensure claims are reimbursable by applicable payers;
  • Understands and complies with all payer guidelines related to claim submission; is knowledgeable and proficient with payer websites and other useful resources pertaining to the billing function;
  • Focuses daily on complying with policies, procedures, and department guidelines for billing and claim edit resolution; and
  • Maintains strict confidentiality and adheres to all HIPAA guidelines/regulations.Required Experience
    • Associates Degree is required
    • At least two years related experience
    • Knowledge of basic medical coding/terminology and third-party insurance operating procedures and practices a plus
    • Knowledge of revenue cycle and/or business office procedures
    • Highly detail-oriented and well-organized
    • Ability to read, understand, and follow oral and written instructions
    • Ability to establish and maintain effective working relationships and communicate clearly with customers and insurance companies both within and outside of Steward Health SystemPreferred Experience
      • Medical billing and coding certification a plus
      • Experience with medical billing software athenaNet preferred Benefits Offered:
        • Paid time off
        • Health/Dental/Vision insurance
        • Healthcare spending or reimbursement accounts such as HSAs or FSAs
        • 401K
        • Employee Assistance Program
        • Tuition Reimbursement
        • And much more

Keywords: Steward Health Care System, Franklin , Accounts Receivable Specialist (SMG West), Other , Franklin, Tennessee

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