A/R Management Representative

Department:  A/R Management
Reports To:  Billing Operations Manager
FLSA Status: Non-Exempt
Prepared By: Christin O’Farrell, HR Manager
Prepared Date: April 12, 2017
Approved By:  Kelly Spilios, Operations Manager
Approved Date: April 12, 2017

I.  SUMMARY

The Representative is responsible for providing quality and efficient services to clients through responsive communications, expedited services, problem resolution, and accurate information.  The Representative ensures maximum reimbursement for services rendered by StreamlineMD clients in the most cost effective manner.  The individual in this position represents the client to the payers and patients, and may cross train in more than one area of A/R Management.

In general, the Representative is responsible for understanding payer specific billing rules related to certain specialties including, but not limited to: Radiology, Endovascular/Interventional Radiology, Interventional Pain Management, and Interventional Vein specialists.  The Representative is also responsible for the timely follow up of open claims for their assigned insurance carriers, correcting claim rejections, reviewing denied claims, filling appeals and working special projects.

II. ESSENTIAL DUTIES AND RESPONSIBILITIES

A.    Accounts Receivable

• Review accounts for accuracy, CPT, ICD-9, ICD-10 coding, insurance, and demographic set up.
• Perform A/R aging analysis and follow up on accounts due.
• Review A/R work queues daily and resolve open claims.
• Submit claims to primary, secondary, and all applicable third party insurers.
• Reconcile account credit balances.
• Research when payments are not received.

B.  Denial Management

• Review claim submission rejections daily and resolve with payers and clearinghouses
• Investigate front-end denials to determine why a claim is denied, and what is required to process and pay the claim.
• Resolve denied claims by resubmitting a corrected claim or filing an appeal when appropriate.
• Address discrepancies such as duplicates, modifiers, or incorrect insurance.
• Determine the basis for an appeal, create letter, and fax or mail to the Payer.
• Identify current insurance when denial is based on coverage.
• Keep up with returned mail by searching for current addresses and resending.
• Determine denial trends or changes in adjudication results with payers and alert management with findings.

C.    Payer Administration

• Contact payers to resolve claims not responded, and to inquire about medical policies.
• Monitor payer websites for news updates and/or changes in medical policies
• Follow up with insurance company and/or patient as appropriate.

D. Client / Patient Communication

• Resolve Client Work Tasks in our software as a priority
• Communicate clearly in emails/notes providing information needed in a friendly, professional manner
• Initiate and respond to telephone inquiries from patients and insurers.
• Answer inbound client calls with helpful information and follow up if needed.
• Process credit card transactions as needed

E.    Confidentiality

• Follow all related HIPAA privacy regulations and other healthcare compliance regulations as determined by StreamlineMD.
• Maintain a strict level of confidentiality for all matters pertaining to any clients, their patients, related documents and computer files.

III. QUALIFICATIONS

• A minimum of two (2) years medical billing experience or comparable education.
• Basic knowledge of EOB statements, HCPCS, CPT, and ICD-9 / ICD-10 coding concepts.
• Effective verbal and written communication skills.
• Ability to organize and prioritize workload.
• Computer skills including Excel.

IV.  EDUCATION

High School education or equivalent required.  Medical administration technical certificate or Associates in medical or business related field is desirable.

Patient Services Representative

Department:  Operations

Reports To: Operations Manager

FLSA Status: Non-Exempt

Prepared By: Christin O’Farrell, HR Manager

Prepared Date: April 12, 2017

Approved By:  Kelly Spilios, Operations Manager

Approved Date: April 12, 2017

I.  SUMMARY

The Patient Services Representative responds to incoming phone calls from radiology patients.  The representative is responsible for discerning the nature of the call, professionally responding to questions, accepting payments when appropriate and documenting the call in the practice management software.  The individual in this position represents the client to their patients, and provides accurate information in a polite manner.

II. ESSENTIAL DUTIES AND RESPONSIBILITIES

• Responds to incoming phone calls from Radiology and Interventional Radiology patients who were provided healthcare services by StreamlineMD client.
• Listens to determine the nature of the call and responds accordingly.
• Applies basic knowledge of insurance and billing rules to accurately respond to callers.
• Works to avoid dropped calls in voice mail, and follows up on any messages.
• Explains Patient EOB or any other questions related to health insurance.
• Encourages payment where there is patient responsibility.
• Processes credit card transactions.
• Refers more complex questions or otherwise difficult calls to Radiology Client Advocate when needed.
• Observes trends in phone call inquiries to determine if process errors or inconsistencies may exist; and, reports these trends to management.
• Utilizes the Practice Management software to investigate patient claims.
• Documents the nature of the call and the action taken for referencing.
• When call volumes are low, works on claim rejections and logs.
• Follows all related HIPAA privacy regulations and other healthcare compliance regulations.
• Maintain a strict level of confidentiality for all matters pertaining to any clients, their patients, related documents and computer files.

III. QUALIFICATIONS

• A minimum of two (2) years medical billing experience or comparable education is preferred.
• Basic knowledge of EOB statements, HCPCS, CPT, and ICD-9 / ICD-10 coding concepts.
• Effective verbal and written communication skills.
• Ability to organize and prioritize workload.
• Customer-focused orientation
• Computer skills including Excel.

IV.  EDUCATION

High School education or equivalent required.  Medical administration technical certificate or Associates in medical or business related field is desirable.