Job description
OUR MISSION AND PERFORMANCE EXPECTATIONS
Sevita is a mission-based organization dedicated to providing high-quality services to those we serve. To deliver on our mission, Sevita expects every employee to perform his or her job, first and foremost, in accordance with the Company’s mission.
SUMMARY
The AR Collections Associate is responsible for following up in a timely fashion on claims that have been paid incorrectly or have not been paid at all. They are responsible for communicating with the field and their supervisor any issues preventing a claim from being sent to the payer. They are also responsible for sending claims to the payer in a timely and accurate manner.
ESSENTIAL JOB FUNCTIONS
To perform this job successfully, an individual must be able to satisfactorily perform each essential function listed below:
Updates collection procedures as necessary
Utilizes Credible and other revenue cycle management systems to review, document, and resolve collection activities, denials, and claim follow-up actions
Reviews and works denials in the workflow system daily, payer portal, and/or clearinghouse portal daily
Reviews and works assigned workflow tasks with follow-up dates that are set to expire on that day and workflow tasks without a payer response once past 30 days from billing
Follows-up with Field on updates to items assigned to them that are past follow-up date
Updates workflow system with clear, concise notes as claims are worked
Notifies Field of denials that require their attention
Notifies biller when claims can be electronically rebilled
Sends out paper or complete web portal billing once any necessary corrections have been made
Communicates with Field Finance and SSC Management on issues with collections
Reviews unapplied cash log for any items that can be applied and works with cash team to resolve
Works credit balances on the aging and overpayment account and follows the credit balance procedure for resolution
Prepares appeal packet as required by payer, scans and saves documentation to be sent, updates workflow system with notes and follow-up dates, and has Supervisor review prior to sending
Follows up on appeal status with payer after 30 days and then on a bi-weekly basis until paid
Completes necessary forms and provides appropriate support for:
◦ Refunds ◦ Cash move ◦ Sales adjustments ◦ Transfer of Liability
Ensures internal control compliance with all assigned areas and other audit requirements
Assists in the onboarding of new hires by providing required training when necessary
Embraces concept mentoring by actively participating in team meetings and fostering an environment in which team members proactively collaborate with one another
Proactively supports management as well as the objectives and goals of the department
Supports special projects, mission critical initiatives, and performs other duties as assigned by the Supervisor
Ensures Sarbanes Oxley compliance with all assigned areas and other audit requirements
Responsible for the maintenance of an effective control environment under SOX 404 for the accounting operations he or she oversees. This includes both key and non-key controls and extends to the timely updating and modification of control design where necessary and the oversight of control remediation activities should exceptions be encountered in testing.
System testing
Performs other related duties and activities as required
SUPERVISORY RESPONSIBILITIES
None Required
Minimum Knowledge and Skills Required by the Job
The requirements listed below are representative of the knowledge, skill, and/or abilities required to perform the job:
Education and Experience:
High school diploma or equivalent required
Experience using Credible EHR/billing software required. Candidates with direct experience working with Massachusetts Department of Public Health (DPH) payer billing and collection processes may be considered in lieu of direct Credible experience.
Associate's or Bachelor's degree in a finance-related field preferred
Two to three years of experience with Medical Collections in a high-volume environment preferred
Knowledge of ICD-10 diagnosis codes and CPT medical service codes
Knowledge of UB-04 and HCFA-1500 forms
Strong understanding of medical collections compliance
Strong understanding of Medicare, Medicaid, Medicaid managed care, Commercial, Workers' Comp, and Auto-no-fault payer types
Certificates, Licenses, and Registrations:
None required.
Other Skills and Abilities:
Must be self-motivated and detail-oriented
Must have excellent communication skills
Must be highly organized with the ability to multitask
Must have analytical skills and the ability to collect information from different sources
Effectively use Microsoft Office (Word, Excel, PowerPoint, Outlook, etc.)
The regular working hours for this position can be performed remotely; however, due to current business and employment requirements, we are unable to employ individuals in this role who will be working from Alaska, Hawaii, New York, Oregon, South Dakota, Vermont, Washington State, or Washington, D.C. Although the role is primarily remote, occasional in-person and related travel is an essential function of this position.
AMERICANS WITH DISABILITIES ACT STATEMENT
External and internal applicants, as well as position incumbents who become disabled, must be able to perform the essential job functions either unaided or with the assistance of a reasonable accommodation to be determined on a case-by-case basis via the interactive process.
Sevita is a leading provider of home and community-based specialized health care. We believe that everyone deserves to live a full, more independent life. We provide people with quality services and individualized supports that lead to growth and independence, regardless of the physical, intellectual, or behavioral challenges they face.
We’ve made this our mission for more than 50 years. And today, our 40,000 team members continue to innovate and enhance care for the 50,000 individuals we serve all over the U.S.
As an equal opportunity employer, we do not discriminate on the basis of race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age, disability, genetic information, veteran status, citizenship, or any other characteristic protected by law
Originally posted on Himalayas
Who can apply
Eligible countries: United States. Accepted UTC offsets: UTC-10, UTC-9, UTC-8, UTC-7, UTC-6, UTC-5, UTC+14. Review the full description for employer-specific work authorization, residency and schedule requirements.