AR Recovery Analyst II (Medicaid)

About FinThrive

FinThrive is advancing the healthcare economy.
For the most recent information on FinThrive's vision for healthcare revenue management visit finthrive.com/why-finthrive.

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About the Role

Impact you will make

Reps typically demonstrate the aptitude and ability to take on critical processes while managing quality production standards. Acts as a mentor to Rep I associates. Responsible for managing moderately complicated insurance denials and underpayments via the Rubixis AR Follow Up software.

What you will do

• Learn and understand our ARO platform and the various resources available.
• Work an assigned number of accounts from start to finish successfully, and in a timely manner.
• Call healthcare insurance companies, their affiliates & providers to resolve any question about contract or payment issues.
• Analyze contract, billing, cash costing, pricing, and collections on accounts in compliance with billing regulations, policies, and procedures.
• Investigate all insurance payments that deviate from expected payment
• Work collaboratively with leadership and other team members to confirm, challenge, or provide trending and solutions
• Accurately document outcome of all research and work performed on accounts or sub accounts in the system
• Accurately use system status codes, follow-up, and mark ahead responses
• Escalate items as appropriate to senior staff or management when appropriate
• Perform validation of bulk underpayment or denial trends
• Follow-up on mid dollar balances (Based on project criteria)
• Create appeals, patient, or payer correspondence
• Maintain full compliance with all regulatory guidelines (HIPAA)

What you will bring

• 3+ years of experience with healthcare insurance billing, follow-up, and collection in a hospital, clinical or BPO vendor environment with a proven track record of success in reimbursement and follow up
• Knowledge of Medicaid payer rules, processes, including how to interpret denial reasons, how to submit appeals to Medicaid payer, and access Medicaid portals
• Basic understanding of HIT systems like EPIC, Paragon, Zirmed or other billing systems
• Able to effectively resolve higher complexity denials and underpayments
• Ability to understand and use payer contract language in calls with payers
• Basic understanding of the healthcare revenue cycle in a hospital or clinical setting
• Intermediate to advanced understanding of insurance billing, reimbursement and follow up processes
• Familiarity with different payer types for claims processing and adjudication
• Ability to identify, understand and use general medical billing terminology including:
  
  
  
  • Claim types (UB/1500)
  • CPT, ICD, DRG Codes
  • EOB/RA
  
  
  
  
• Proficient understanding and interpretation of information and terminologies contained in payer correspondence
• Excellent written and verbal communication
• Proficiency with basic mathematic functions (addition, subtraction, multiplication, division)
• Problem-solving and organizational ability
• Able to consistently maintain or exceed minimum average daily productivity & quality after 90 days
• Understanding of Patient Accounting system/EMR
• Skills for MS-Office (Word & Excel) applications

What we would like to see

• Degree in related field
• Certification in billing or medical coding
• 2+ years of experience in UB-04 Follow-Up and/or Contract/Reimbursement Analysis, including investigation of both pricing and reimbursement variances
• 2+ years of experience with Medicaid processes and systems

FinThrive's Core Values and Expectations

• Demonstrate integrity and ethics in day-to-day tasks and decision making, adhere to FinThrive's core values of being Customer-Centric, Agile, Reliable and Engaged, operate effectively in the FinThrive environment and the environment of the work group, maintain a focus on self-development and seek out continuous feedback and learning opportunities
• Support FinThrive's Compliance Program by adhering to policies and procedures pertaining to HIPAA, FCRA, GLBA and other laws applicable to FinThrive's business practices; this includes becoming familiar with FinThrive's Code of Ethics, attending training as required, notifying management or FinThrive's Helpline when there is a compliance concern or incident, HIPAA-compliant handling of patient information, and demonstrable awareness of confidentiality obligations

The physical demands and work environment characteristics described here are representative of those that a colleague must meet to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.