The Revenue Cycle AR Specialist II is responsible for resolving insurance balances, following up with payors, and submitting appeals and reconsideration requests on rejected and denied claims. Ensures claims are paid by insurance carrier to the organization correctly. Works receivable inventory within department standards, including, as applicable: maintaining assigned list of hospital or professional accounts; documenting agreement arrangements or reasons for outstanding balances; performs collection and follow-up efforts; coordinating and/or posting adjustments, contractual allowances, or refunds within levels of authority.
Identifies root causes of insurance denials. Remains current with core knowledge of specific payer policies, contracts, and administrative bulletins.
Responsibilities:
• Resolves insurance balances • Follows up with payors • Submits appeals and reconsideration requests on rejected and denied claims • Ensures claims are paid by insurance carrier to the organization correctly • Works receivable inventory within department standards • Maintains assigned list of hospital or professional accounts • Documents agreement arrangements or reasons for outstanding balances • Performs collection and follow-up efforts • Coordinates and/or posts adjustments, contractual allowances, or refunds within levels of authority
About Connecticut Childrens
Connecticut Childrens is the only health system in Connecticut that is 100% dedicated to children. Established on a legacy that spans more than 100 years, Connecticut Childrens offers personalized medical care in more than 30 pediatric specialties across Connecticut and in two other states. Our transformational growth establishes us as a destination for specialized medicine and enables us to reach more children in locations that are closer to home. Our breakthrough research, superior education and training, innovative community partnerships, and commitment to diversity, equity, and inclusion provide a welcoming and inspiring environment for our patients, families, and team members.
At Connecticut Childrens, treating children isnt just our job - its our passion. As a leading childrens health system experiencing steady growth, were excited to expand our team with exceptional team members who share our vision of transforming childrens health and well-being as one team.
Education and/or Experience Required:
Education: High School Diploma, GED, or a higher level of education that would require the completion of high school.
Experience: Minimum of 3 years Billing experience required in healthcare Rev Cycle with specialization in billing, account receivable follow-up, and denial management, with a High School Diploma/GED OR Minimum of 2 years direct experience with an Associate or Bachelors degree
Education and/or Experience Preferred:
Education: Associates Degree in Healthcare Management, Finance, or related field.
Experience: Experience with Epic
License and/or Certification Required: N/A
Key Responsibilities:
• Identifies root causes of insurance denials • Remains current with core knowledge of specific payer policies, contracts, and administrative bulletins • Communicates identified payer trends such as denials for specific procedure, diagnosis codes, or other identified issues • Accurately and compliantly resolves insurance balances after payment or adjudication, and correctly identifies any patient liability • Ensures accurate resolution of account to payment or payor terms • Follows up with payors to ensure timely resolution of all outstanding claims, via phone, emails, fax, or websites • Leverages available resources and systems (both internal and external) to analyze patient accounting information and take appropriate action for payment resolution • Documents all activity in accordance with organization and payor policies • Coordinates appeal when claim is denied • May partner with medical care team members on complex appeals • Submits LOMN (Letter of Medical Necessity) and other drafted appeals and reconsiderations on rejected and denied claims • Sends appeals to payors and follows up to ensure payment is made • Continues to review account and escalates as necessary if denial is not overturned • Engages the CFC, UR, Revenue integrity, or coding follow-up team for any medical necessity, auth, or coding related to denials review • Sets follow-up activities based on status of the claim; ensures full and clear account documentation on account status within system • Collaborates as a part of a team on special projects by utilizing Excel spreadsheets and effectively communicates results • Performs other job-related duties as assigned.