ASC Collections Specialist

ABOUT AUSTIN REGIONAL CLINIC :

Austin Regional Clinic has been voted a top Central Texas employer by our employees for over 15 years! We are one of central Texas’ largest professional medical groups with 35+ locations and we are continuing to grow. We offer the following benefits to eligible team members : Medical, Dental, Vision, Flexible Spending Accounts, PTO, 401(k), EAP, Life Insurance, Long Term Disability, Tuition Reimbursement, Child Care Assistance, Health & Fitness, Sick Child Care Assistance, Development and more. For additional information visit

PURPOSE

Performs all duties required to accurately monitor and resolve unpaid, denied or underpaid claims, post payments and appropriate adjustments, and assist patients with billing inquiries and follow up on unpaid patient balances. Carries out all duties while maintaining compliance and confidentiality and promoting the mission and philosophy of the organization.

ESSENTIAL FUNCTIONS

Claims Resolution

• Denial Follow Up work queues :
• Takes timely and appropriate follow up action on denied claims based on the X12 CARC / RARC Reason Code and payor policies / statutes. Either submits corrected claims, prepares reconsiderations or appeals, performs accurate adjustment actions, or assigns financial responsibility to the next responsible party in accordance with company policy.
• Collaborates with ASC Billing Specialist to obtain coding reviews and prior authorization corrections for reconsiderations and appeals.
• Communicates with facility staff when necessary to obtain information to edit claim data, and other assistance with follow-up and / or appeal actions.
• Edits claims through Correct / Repost actions to reflect complete, accurate & updated information on replacement claim, when necessary.
• Accurately documents issues, sources, and actions taken to describe activities and results in the Follow-up Activity sidebar.
• Prepares and submits medical necessity appeals together with the supporting documentation in accordance with payor policy.
• Zero Response Work Queues :
• Utilizes payor websites & other resources for claims status on unpaid claims aged 30+ days. When necessary, requests missing EOB’s or payments.
• Responds to payor correspondence in a timely manner and documents follow-up actions.
• Meets department productivity standards.
• Interprets managed care contracts and fee schedules to ensure claims are processed correctly.
• Submits adjustments to ASC Billing Manager for approval and processing, via work queue actions.
• Identifies and documents new Payor coding denial trends and immediately notifies ASC Billing and ASC Business Office Management for escalated follow-up.
• Notifies ASC Billing Manager when all usual attempts to collect from third parties have failed to result in adequate reimbursement for escalation to insurance provider representatives.

Payment posting

Patient Accounts and Collections

OTHER DUTIES AND RESPONSIBILITIES

QUALIFICATIONS

Education and Experience

Required : High school diploma or GED. Two (2) or more years of related experience working with medical billing in an ASC facility setting.

Preferred : Experience working with ANSI denial codes, CPT, ICD-9 and HCPCS coding. Experience using computer data processing systems.

Knowledge, Skills and Abilities

Work Schedule : Monday through Friday from 8am to 5pm.

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws.

For further information, please review the Know Your Rights notice from the Department of Labor.