Account Receivable Specialist III - PRCMApply Now
Xtend Healthcare, LLC, provides entirely revenue cycle-based projects which range from complete business office outsourcing to A/R legacy cleanup, self-pay and third-party CBO safety net engagements as well as coding and consulting engagements.
We serve clients of all types and sizes in all 50 states -- from critical-access hospitals to those with more than 2,000 patient beds, and from individual facilities to multi-hospital, university-affiliated health systems.
In 2015, Xtend was acquired by Navient, the nation's leading loan management, servicing and asset recovery company. By joining forces with Navient, the Xtend team will be bolstered by the strength, stability and resources of an industry leader, and leverage the parent company's large-scale business process outsourcing capabilities.
Xtend Healthcare is looking for an Accounts Receivable Specialist III - PRCM. The Accounts Receivable Specialist is responsible for review and resolution of outstanding insurance balances on physician patient accounts. The Accounts Receivable Specialist will be required to have flexibility to learning and comprehending complex hospital and physician systems along with a keen analytical skills to evaluate appropriate next steps to bring aged account receivables to resolution. The Accounts Receivable Specialist will be responsible to ensure cash recovery goals are met and assigned hospital receivables are appropriately addressed according to company, client and federal guidelines.
1. Effectively manages assigned insurance receivables to achieve business line expectations.
- Exceed productivity standards as outlined by business line.
- Exceeds a minimum of 85% work quality scoring and accuracy on all accounts worked.
- Completes timely follow-up on assigned accounts to ensure no cash loss.
- Exceeds monthly cash expectations as set out for assigned client receivables.
- Ensures insurance accounts are resolved within 90 days of placement.
- Demonstrates the ability to prioritize work with minimal oversight to meet outlined goals.
- Acts as a knowledge resource for team members.
2. Perform account research and route accounts through appropriate client workflows.
- High level understanding of client host system functions.
- Clearly documents actions taken and next steps for account resolution in patient accounting system.
- Excellent working knowledge of Prism system and displays clear understanding of claim updates, request workflow, and action step entry into the system.
- Demonstrates advanced understanding of commercial and Medicaid payers.
- Has knowledge of Medicare guidelines and is able to accurately perform corrections according to CMS guidelines.
- Demonstrates advanced understanding of claim needs and ability to accurately perform needed billing activities (Evaluation/Correction of billing edits, claim transmission, rejections, and other claim functions).
- Compiles appeals and approves appeal requests for team related to technical payment denials.
- Demonstrates the ability to act as request approver for team members to ensure accurate actions are taken for account resolution.
- Reflects understanding of payer contract verbiage and the ability to negotiate payment utilizing contract terms.
- Ensure strong communication skills to convey intricate account information.
3. Ensure all accounts are worked within client standards and Federal Regulations.
- Maintain high quality account handling per client standards.
- Work within federal, state regulations, department/division & all Compliance Policies.
- Maintain clear, concise and accurate documentation of all attempts and/or contacts made and received for accounts in accordance with company and client specifications.
4. Maintain continuing education, training in industry career development.
- Maintain current knowledge of and comply with all federal and state rules and regulations governing phone calls and collections including HIPAA, FDCPA, Privacy Act, FCRA, etc.
- Attend training sessions as directed by management.
- Integrate information obtained through training sessions and policy changes immediately into daily routine.
- High school diploma (Additional equivalent experience above the required minimum may substitute for the level of education).
- 3+ years experience in a health care receivables environment.
- Excellent oral and written communication skills
- Basic computer skills
- Familiar with widely used patient accounting software
- Organization, planning and prioritizing
- Communication skills
- Data management
- Attention to detail and accuracy
- Adaptability and flexibility
- Possess excellent reading and writing skills
- Strong Computer skills
- Ability to communicate successfully with patients, hospital or Xtend Employees
- Is able to work individually and as part of a team
- Possess ability to concentrate for long periods of time
- Proficient in numeracy skills
- Pays close attention to detail
- Must possess excellent grammar and spelling skills
- Proficient in knowledge and use of email and internet
- Possess above average knowledge of administrative procedures
All offers of employment are contingent on standard background checks. Navient and certain of its affiliated companies are federal, state and/or local government contractors. Should this position support a Federal Government contract, now or in the future, the successful candidate will be subject to a background check conducted by the U.S. Government to determine eligibility and suitability for federal contract employment for public trust or sensitive positions. Positions that support state and/or local contracts also may require additional background checks to determine eligibility and suitability.
EOE Race/Ethnicity/Sex/Disability/Protected Vet/Sexual Orientation/Gender Identity. Navient Corporation and its subsidiaries are not sponsored by or agencies of the United States of America.
Navient is a drug free workplace.