Job Description

OUR MISSION AND PERFORMANCE EXPECTATIONS
Sevita is a mission-based organization dedicated to providing high-quality services to those we serve. Therefore, to deliver on our mission, The Network expects every employee to perform his or her job first and foremost in accordance with the Company’s mission.

The AR Collections Specialist 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 about 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 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
• Associates 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
• 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.
• 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.)
Other Requirements:
• Travel as needed
Physical Requirements:
• Sedentary work. Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
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