Infinx Hiring for AR Specialist, Healthcare at Spring, TX Full Time

ABOUT THE ROLE

The Accounts Receivable Specialist will be responsible for hospital compliance and quality improvement programs and will monitor compliance with billing rules/regulations by conducting reviews/audits of medical record notes to the billing department; evaluate the adequacy and effectiveness of internal and operational controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and guidelines related to facility and technical fee documentation, coding and billing, including federal and state regulations and guidelines, CMS and other third party payor billing rules, and OIG compliance standards.

RESPONSIBILITIES:

• Interact with internal departments such as Customer Service, Medical Management, Configuration, Contracting, Claims, and Provider Relations, as well as providers and other external entities, to process provider disputes efficiently and appropriately.
• Conduct standardized audit scoring methodology to consistently evaluate documentation and coding, and standardized audit findings methodology to audit results.
• Communicate audit results to hospital service departments and departmental leadership, physicians, physician leadership, senior hospital management, coders, billers and other appropriate staff, provide physician and coder education and make recommendations for management corrective action.
• Serve as institutional subject matter experts and authoritative resources on interpretation and application of documentation and coding rules and regulations, medical necessity of services delivered, and conduct enterprise risk assessments of potential and detected compliance deficiencies.
• Investigate provider disputes to determine the source of the complaint.
• Use appropriate, understandable correspondence to communicate decisions.
• Ensure revenue integrity
• Maintain CDI process
• Responsible for charge capture
• Work directly with the manager to meet the needs of the department.
• Other departmental Ad Hoc Payment Integrity functions

SKILLS & EDUCATION:

• Understanding of Medicare and Medicaid billing rules. Knowledge of Microsoft Office Suite software.
• A bachelor’s or associate’s degree in a related field is preferred.
• 2 years of experience in health insurance/managed care.
• Knowledge of medical terminology is preferred.
• Excellent written and oral communication skills
• Microsoft office products will be included in PC proficiency.
• The option of remote deployment will be considered.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

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