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AR Team Lead (Healthcare)

Duties & Responsibilities

  • Verify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the insurance carrier/providers
  • Update patient demographics/insurance information in appropriate systems Research/ Status unpaid or denied claims
  • Monitor claims for missing information, authorization, and control numbers (ICN//DCN)
  • Research EOBs for payments or adjustments to resolve claim
  • Contacts payers via phone or written correspondence to secure payment of claims Access client systems for payment, patient, claim and data info
  • Follows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems
  • Secure needed medical documentation required or requested by third party insurance carriers.
  • Maintain confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure
  • Perform other related duties as required
  • Utilize provider billing manuals to obtain billing guidelines and requirements.
  • Write appeal letters for technical appeals
  • Verifies accuracy of underpayments utilizing contracts and claims data.
  • Prepares claims for clinical audit processing in the case of authorization, coding, level of care and/or length of stay denials
  • Utilizes reports for analysis and to monitor follow up activities and prioritization
  • Assists organization with working through special projects as needed
  • SME for colleagues and provide direction for resolution of accounts
  • Assists in new hire training
  • Assists in content building of training materials

Qualifications & Competencies

  • 3+ years of medical collections/billing experience
  • 2+ years of experience as a Team Leader
  • Intermediate knowledge of ICD-10, CPT, HCPCS and NCCI
  • Expert knowledge of third-party billing guidelines
  • Expert knowledge of billing claim forms (UB04/1500)
  • Expert knowledge of payor contracts
  • Working Knowledge of Microsoft Word and Excel
  • Intermediate working knowledge of health information systems (i.e., EMR, Claim Scrubbers, Patient Accounting Systems, etc.)
  • Must be willing to work onsite.

Preferred Qualifications

  • Working knowledge of one or more of the following Patient accounting systems – EPIC, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts or Paragon
  • Prior team lead experience
  • Working knowledge of DDE Medicare claim system
  • Knowledge of government rules and regulations

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