Overview

The Insurance A/R Specialist is responsible for accurate and timely posting of payments, denials, refunds, and adjustments to patient accounts within the practice management system(s). The Specialist verifies deposits, reconciles payment batches, assists with insurance aging reports and claim follow up for offices. This position is responsible for identifying and reporting inefficiencies and opportunities to accelerate cash posting and account resolution.

Essential Duties and Responsibilities

• Posts patient and insurance payments deposited in EDP’s bank accounts electronically and manually across multiple practice management systems.
• Ensures funds are received and deposited prior to posting to patient accounts. Reconciles remittance advice and/or explanation of benefits to the respective source.
• Maintains all reconciliation spreadsheets in a shared electronic folder.
• Locates patient accounts across multiple practice management systems to accurately post bulk payments from third-party payors.
• Researches patient and insurance refund requests for appropriateness, refund amount, and refund recipient. Follows EDP’s and payor protocols when processing refunds and refund adjustments. Appeals refund requests with third party payors as appropriate.
• Monitors and analyzes clearing accounts and account credits to identify course of action required to resolve transactions via refund, transfer of payment, or reversal of contractual allowance. Acts on account as appropriate.
• Researches and resolves all unidentified cash and unapplied cash timely and accurately.
• Utilizes critical thinking to research reasons for discrepancies and identify root cause of payment issues or exceptions.
• Assists Manager to ensure batches are balanced prior to end of day.
• Documents using standardized notes, all refund and account resolution activities in the practice
  management system.
• Performs back up to the Treasury Analyst by resetting practice personnel passwords for merchant accounts.
• Partners with Treasury Analyst to reconcile deposits between practice management systems and multiple bank accounts.
• Collaborates with the Manager and Revenue Cycle Training to develop processes and training material for, but not limited to, bulk payments, daily reconciliation, and cash collections for the Practices.
• Meets department and individual productivity, quality standards, and key performance metrics.
• Remains current with trends, regulatory requirements, and business strategies related to the revenue cycle.
• Operates in compliance with all local, state and Federal laws as well as EDP policy and compliance standards.
• Helps foster a positive productive work environment.
• Other duties and responsibilities as assigned.

Qualifications

• High School Diploma required; Bachelor’s Degree preferred.
• 2-3 years of related experience working within a centralized healthcare cash application or treasury team; Preference for dental or medical group experience.
• Expertise in interpreting and applying third party payor explanation of benefits.
• Ability to handle payment posting for multiple accounts across multiple practice management systems.
• Experienced researching internal and external documents, general ledger transactions, and claim payments to determine appropriate action for account resolution.
• Detail oriented with a high level of organization, analytical, and problem-solving skills.
• Excellent multi-tasker with ability to remain calm in fast paced environments.
• Ability to work autonomously and efficiently within designated timeframes or deadlines.
• Communicates effectively orally and in writing.
• Proficient with Word and Excel.