Accounts Receivable Representative

Manhattan Specialty Care is looking for an Accounts Receivable Specialist who is responsible for managing the accounts receivable process, focusing on reviewing denials, submitting appeals and ensuring timely reimbursements from commercial insurance carriers. This role requires a strong understanding of insurance policies and excellent communication skills to represent the practice effectively.

Responsibilities:

1. Review and analyze denied claims to identify reasons for denial.
2. Prepare and submit comprehensive appeals to insurance carriers to secure reimbursement.
3. Utilize in-depth knowledge of commercial insurances, including Aetna, Anthem BCBS, Cigna, GHI, and UHC, to effectively navigate denial trends and policies.
4. Monitor and manage aging reports, focusing on claims that are 30, 60, and 90 days old to recoup outstanding reimbursements.
5. Develop strategies to reduce aging claims and improve cash flow.
6. Review Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs) to identify patterns and trends in claim denials.
7. Document findings and make recommendations for process improvements.
8. Conduct thorough research on insurance policies and guidelines relevant to appeals.
9. Maintain organized documentation of all billing activities and correspondence related to claims.
10. Communicate professionally and effectively with patients, vendors, and insurance carriers, representing the practice's values and standards.
11. Address inquiries and provide updates regarding claims status to stakeholders.
12. Work collaboratively with the billing team to support overall revenue cycle management.
13. Seek assistance from the AR Supervisor and colleagues when needed to resolve complex issues.
14. Assist in the preparation of regular reports on billing activities and denial trends using Excel and other reporting tools.
15. Contribute to departmental meetings by sharing insights and suggestions for improvement.

Qualifications:

1. Proven experience in medical billing and accounts receivable management.
2. Strong understanding of commercial insurance policies.
3. Familiarity with Eclinicalworks system (ECW) (preferred).
4. Proficiency in Microsoft Excel and basic reporting skills.
5. Excellent written and verbal communication skills.
6. Strong organizational skills and attention to detail.
7. Ability to work independently and manage multiple priorities effectively.
8. Self-driven with a proactive approach to problem-solving.