Job Description

We are seeking a qualified candidate to fill our AR Specialist position to assist with all financial operational needs for our patients.

Provides accurate and timely submission of claims for Your Health to various payer sources based on timely filing guidelines. Ensures specialty accounts are followed up on in a timely manner with increased focus on aged and high dollar accounts. Follows up and pursues identified payer variances after comparing expected to actual reimbursement received. Responsible for working with other departments when issues arise such as missing payments, payer delays, and technical denials. Ensures payment amount(s) from insurance carriers are correct and posted to accounts. Reviews accounts after payment posting to determine if balance needs moved to secondary payer or patient liability. Knowledge of payers and provides support to other team members as needed. Demonstrates exceptional relationships with external payers and internal departments in accordance with Your Health Standards of Behavior and Compliance.

Essential Functions

All team members are expected to be knowledgeable and compliant with Your Health's values: Inspire health. Serve with compassion. Be the difference.

Works and processes the billing functions, including resolving the discharged not final billed/stop bill errors that prevented the account from billing, the resolution of claim edits in order to submit to claims clearinghouse for electronic submission. Processes the daily paper claims submissions for primary and secondary claims.

Follows up on specialty accounts receivable (AR) accounts assigned to determine if the claim has been accepted and processed for payment or denied. Reviews claim rejections and re-bills accounts when appropriate. Effectively and timely identifies the root cause of non-payment denials and works with the insurance company, the patient and Your Health departments to find resolution to claim denials, making all necessary claim and account corrections to ensure the full reimbursement of services rendered.

Escalates accounts both at the payer and/or internally when appropriate, as well as involving the patient appropriately in accordance with the Your Health escalation guidelines in order to keep AR aging at acceptable levels for payer issues.

Must have prior experience with Claims and Insurance Denials

This position will be working in the Corporate on an in-person / remote schedule. This is a full-time, salary-based 8-hr position Monday-Friday (8:00AM-5:00PM).

About

We are a leading physician group serving South Carolina and Georgia, dedicated to delivering quality healthcare directly to patients in care facilities, homes, clinics, and virtual visits. Our services include comprehensive primary care, specialty services, and pharmacy support, tailored to meet diverse patient needs. Committed to excellence and innovation, our team collaborates closely with facilities and families to ensure accessible, coordinated, and compassionate care.

Why Choose a Career at Your Health?

Providing high quality care for our patients is the center of what we do, and we provide the same care for our employees. Here are some of the benefits that are available to our employees.

• Competitive Compensation Package with Bonus Opportunities
• Employer Matched 401K
• Free Visit & Prescriptive Services with HDHP Insurance Plan
• Employer Matched HSA
• Generous PTO Package
• Career Development & Growth Opportunities

What Are We Looking For?

Your Health is currently looking for an Accounts Receivable Specialist to join our growing Primary Care family. A successful Accounts Receivable Specialist will be able to perform these essential duties and responsibilities. Reasonable accommodations may be made, in accordance with applicable law, to enable individuals with disabilities to perform the essential functions.

The following is a list of essential functions, which may be subject to change at any time and without

notice. Management may assign new duties, reassign existing duties, and/or eliminate function(s)

Areas of Responsibility:

• Monitor and validate patient insurance for assigned regions utilizing the specific software and reports.
• Answer patient and employee questions related to, but not limited to, copayments, insurance, billing, collections, coverage, etc.
• Assist with cash and insurance collections.
• Provide assistance to statewide Accounts Receivable team.
• Responsible for ongoing insurance validation.
• Provide critical financial information for new patients and clients.
• Update patient financial information including current primary and secondary insurances.
• Monitor and report on key revenue cycle metrics, identifying trends and areas for improvement.
• Perform audits on Care Management patients.
• Assist patients with billing inquiries, payment plans, and financial assistance options.
• Provide support to staff in navigating billing software and resolving patient financial concerns.
• Foster a culture of exceptional customer service and patient-centered care within the office.
• Serve as a liaison between the office staff and regional leadership, ensuring clear communication and coordination.
• Assist with any service suspensions or discharges.
• Work with your team to resolve patient insurance issues and determine the appropriate action for upcoming appointments.
• Participate in coaching calls.
• Perform other duties as requested or required, at the sole discretion of the Company.

Qualifications

• Education - High School diploma or equivalent OR post-high school diploma/highest degree earned
• Experience - Three (3) years in hospital claims and billing follow-up
• In Lieu Of Bachelor's degree and 2 years of hospital billing, follow-up/denials.
• Required Certifications, Registrations, Licenses
• CRCA preferred
• CRCR preferred
• Knowledge, Skills and Abilities
• Understanding of the hospital and physician claim forms
• Knowledge of payer guidelines.
• Maintains professional growth and development through seminars, workshops, in-service meetings, current literature and professional affiliations to keep abreast of latest trends in field of expertise.
• Understands, promotes and adheres to all matters of compliance with laws and regulations.
• Understands the Standards of Behaviors.
• Communication skills preferred
• Attention to details preferred.