Position Summary

The Accounts Receivable Specialist role and responsibilities include: monitoring all aspects of the
collection of outstanding debts owed to the health system including following up directly with
commercial and governmental payers to resolve claim issues and secure appropriate and timely

reimbursement, resolve missing and unresolved payment issues, and monitor overdue accounts,
Identify and analyze denials and payment variances and takes action to resolve
accounts including drafting and submitting technical appeals. In addition, the AR specialist is the
subject matter expert for all billing staff regarding insurance payer billing procedures.

Primary Position Responsibilities

Maintains a complete understanding of the appropriate account follow-up resolution protocols and
required software programs. Utilizes all software systems in accordance with Patient Account
protocols, and addresses account write-offs in accordance with Hunterdon’s Account Adjustment
Policy and Procedures. Develops and maintains a working knowledge of all governmental and non-governmental payer
contractual requirements including CMS guidelines, Medicaid Guidelines, and Hunterdon’s
private payer contracts. Responsible for managing tasking queue in accordance with daily, weekly, monthly, quarterly,
and annual tasks to resolve all accounts within defined payor guidelines and meeting or
exceeding productivity and quality standards and goals as defined by the Business Office
Management Team. Responsible for reviewing and taking action on aged accounts receivables to include following up
with payers to ensure timely resolution of all outstanding claims via phone, emails, fax, or payer
portals. Responsible for identifying and correcting medical billing errors, initiating required follow-
up actions, and submitting or resubmitting claims to third-party insurance carriers and
governmental payers in accordance with filing guidelines. Responsible for creating evidence to dispute denied claims based on payer reimbursement rules
when claims are erroneously denied through investigating root cause of denial, compiling of data
to support the overturning of a denial, and creating the appeal documents, as well as following
through on communication with third-party payer to complete the recovery of denied funds. Responsible for providing support to billers and patient account representatives when an
explanation of patient responsibility is necessary. Responsible for reviewing account information to identify and analyze trends involving
preventable root cause issues and payer denials. Responsible for communicating identified
trends and issues to Business Office leadership and will perform special projects as needed.

Qualifications

Minimum Education: Required: High School Diploma or Equivalent Preferred: Associate’s Degree in Business Administration
Minimum Years of Experience (Amount, Type and Variation): Required: Physician/Professional Billing Experience: 3+ years required experience in
insurance payer contracts, submitting appeals, and a complete understanding of
insurance payer’s explanation of benefits and payer reimbursement rules. Preferred: 2 years accounts receivable follow-up experience
License, Registry or Certification: Required: none Preferred: none
Knowledge, Skills and/or Abilities: Required: Must have strong organizational, problem solving and critical thinking skills Experience working with insurance payer portals such as Navinet and Availity. Knowledge of Medical Terminology, CPT Codes, Modifiers and Diagnosis Codes Ability to analyze, identify and resolve issues causing payer payment delays Ability to work well individually and in a team environment Experience with practice management system, NexGen preferred; intermediate skills with Microsoft Office Strong communication skills/oral and written Preferred: none