Sr Account Receivable Specialist

Hello prospective future team-member.

Thank you for your interest in Timothy Groth MD PC. We are a out patient pain management and chiropractic practice based in Long Island NY. We serve patients in the community who have Medicare, WC, NF, and commercial insurances including Healthfirst, Fidelis, BCBS, Aetna, UHC, Cigna, Emblem, GHI, Magnacare, and more. Since 2020 we have worked with people in the Philippines directly hired by our practice. We currently have a team of about 15 people in the Philippines helping with all different aspects of the practice. Many of our team members in the PH have been with us for 2-5 years and seem to really like the work community, culture, and environment. As a practice we are committed to ensuring the members of our team have a good experience, stable job, and opportunity to grow. We are looking for someone with the experience and capabilities below but are especially looking for someone with extensive experience working the RCM process, specifically with denials. Please note if you have experience working in specialties including AR for DME, Pain management, Chiropractic, or Primary care as we are looking someone with outpatient specialty experience if possible.

1. Ability to document accounts proficiently in an EHR and the information that is needed for clear understanding.

2. Proficiency in the Appeal process and what is needed to get a claim paid.

3. Senior level understanding of claim follow up and attention to details

4. Investigate denied claims in its entirety and a clear understanding as to why claim was denied.

5. Work all denials that pertain to but not limited to, Duplicate Claim, Timely Filing, EOB requests, Not Medically necessary denials, COB denials.

6. Responsible for reviewing denial trends, identifying the root cause and escalating to Management .

7. Provide feedback on how to improve current processes to eliminate future denial occurrence.

8. . Have a Sr. level understanding of the corrected claim process and when a claim should be corrected and what is needed for this process.

9. Proficient in LCD/Modifier/DX /CPT combination and when it is needed.

10. Proficient in navigation on provider portals.

11. Clear understanding in Medicare and Commercial guidelines.

12. Understanding directives and adhering to SOP (Standard Operating Procedures) in the practice.

14. Responsible for maintaining a daily account review of above 25 accounts (subject to change).

15. Strong Follow up experience required

16. Pain Management experience a plus