Accounts Receivable Specialist - Home Medical Equipment

Performs all duties related to Medicare, Medicaid and insurance coverage verification and negotiating of rates, claims, processing,

and collections by performing the following duties.

Essential Duties and Responsibilities

Include the following and other duties may be assigned:

1. Verify eligibility, obtain benefit quotes, authorizations for services, negotiates reimbursement as appropriate, notify patients of

coverage criteria and verify qualifications are met for reimbursement by individual payor guidelines.

2. Prepares daily cash deposits for posting, updates cash log, verify payment accuracy, post payments, and determine appropriate

contractual adjustments, deductibles and co-pays. Researches and processes refunds, returns and bad checks.

3. Confirm revenue generated accurately. Audit charges/claims for qualifications by the appropriate payor's guidelines. Submit

claims electronically or by paper according to payor's specifications and filing limits. Update all HCPC codes, modifiers, ICD10 codes

according to payor's requirements.

4. Review and process unpaid claims for assigned accounts. Work and track denials and all correspondence from assigned payors.

Prepare formal appeals according to payor's specifications. Monitor appropriate reimbursement based upon contractual agreements

and fee schedules. Obtain necessary documents from patient's medical records. Identify and adjust ineligible revenues,

contractuals and uncollectibles/bad debts. Responsible for the timeliness of payments and minimizing the risk of uncollectibles/bad

debts based upon industry standards.

5. Calls and/or mails correspondence, statements and invoices to customers as necessary in order to update accounts. Maintain

patient account notes with all correspondence, calls or any activity on the account. Receive calls and explain coverage criteria and

the calculations of the charges.

6. Performs month end close functions including financial, tracking and productivity reporting.

7. Complies with guidelines specific to accounts receivable policy and procedures, regulatory bodies, payor sources, individual

company's policy and procedures and other appropriate sources. Maintain knowledge on payor requirements and guidelines.

8. Maintains knowledge of products and services available through the department and other associated organizations.

9. Protects confidentiality of information. Follow guidelines for the release of medical information.

Education:

High School Diploma/ GED required

Computer skills, verbal communication skills and written communication skills. Preferred previous experience in medical, billing or related fields, medical terminology, ICD10 codes and HCPC codes.