A/R Representative - RCM

Do you have the passion to make an impact on people’s lives? Then come join our team! CareCentrix is committed to making the home the center of patient care.

As an A/R Representative - Revenue Cycle Management, you will be responsible for the follow up of outstanding A/R and resolution of denials for various payers. As such, the responsibilities include effective research and resolution of AR work queues and handling of all insurance related correspondence or patient accounts is required to maximize reimbursements. 

In this role, you will:

• Ensure the coordination of invoice activities leading to timely reimbursement of receivables using available resources including databases, internet, and telephone.
• Research and resolve denials received that have not passed payer edits and may lead to a final appeal of denied services. Requires knowledge of a variety of system applications both internal and external. Determines and initiates action to resolve rejected invoices, prepares payer corrections, and/or appeals using electronic and paper processes.
• Provide guidance, assistance, education, and communications with internal and external customers related to insurance and government payers claims processing protocols.
• Utilize various resources to determine patient’s eligibility, benefits, and health plan confirmation. Including online payer databases, CareCentrix Eligibility platforms, and medical records that may result in provider or payer recoup/rejection activity.
• Oversee accounts receivable adjustments to resolve overpayments and payment rejections according to standard operating procedures. Analyzes and clears payment variances. May prepare adjusted and corrected  claims/invoices or adjust accounts receivable entries in accordance with existing operating procedures. May include the use of special reporting.
• Evaluate, analyze and monitor the processing of invoices and on-line notes, utilizing a Windows based data processing system. Monitors payer responses, using Microsoft Excel, Microsoft Access and other software as necessary to ensure prompt payment.
• Contact providersand/or patients to retrieve appropriate medical documentation to substantiate services provided and engage them in assisting CareCentrix in collecting for the payer.
• Provide payers with detailed itemization of services performed to ensure timely reimbursement.
• Review EOPs/EOMBs/EOBs for accuracy of patient responsibility.
• Provide input on accounts receivable process improvements and assisting in their implementation.
• Participate in teleconferences covering a wide range of topics that enables the Revenue Cycle Management division  to effectively collect account receivables.
• Work with internal customers to identify issues which may result in updated processes/workflows and new enhancements or platforms as necessary.
• Maintain departmental quality standards to maximize CareCentrix health plan collections and account resolution.
• Participate in special projects and performs other duties as assigned.

You should get in touch if you have:

• High School Diploma or equivalent; plus minimum of 1 years of experience in Revenue Cycle Management Operations, preferably in the medical, insurance or healthcare field generally required
• Knowledge of healthcare collection procedures and related internal and external software applications are required
• Effective analytical, verbal and written communication skills are required as well as knowledge of HIPAA, HCPCS, CPT, ICD-9 & ICD-10 coding
• Basic competency of Microsoft office applications and mathematical calculations is required
• Must be well organized and possess excellent time management skills

What we offer:

• Competitive Salary Range: $16.35-$22.00/hour plus Corporate Bonus Plan
• Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match
• Generous PTO, 401K Savings Plan, Paid Parental Leave, free on-demand Virtual Fitness Training and more
• Advancement Opportunities, professional skills training, and tuition /exam reimbursement
• PayActiv - access earned income in between pay checks
• Walgreens Discount - receive up to 25% off eligible items
• Great culture with a sense of community

CareCentrix maintains a drug-free workplace

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We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.

CareCentrix accepts applications on an ongoing basis until a candidate is identified.