Senior Analyst - Accounts Receivable

Job Role:

Location:

Summary:

The Senior AR Collections Agent is responsible for the timely and effective collection of outstanding accounts receivable (AR) for healthcare services. This role involves in-depth knowledge of medical billing, coding, payer regulations, and collection techniques. The Senior Agent handles complex cases, provides guidance to junior team members, and plays a key role in improving the overall collection process.

Key Responsibilities:

Collections Activities:

• Manage and resolve complex and high-dollar AR claims.
• Investigate and analyze aged AR to determine appropriate collection strategies.
• Contact insurance companies, patients, and other responsible parties to pursue payment.
• Document all collection activities accurately and thoroughly in the billing system.
• Review and interpret Explanation of Benefits (EOBs) to identify discrepancies and denials.
• Appeal denied claims and follow up on pending appeals.
• Negotiate payment plans with patients according to established guidelines.
• Identify and escalate problematic accounts to management for further action.
• Understanding of HIPAA regulations and ensure compliance in all activities.
• Stay current on changes in payer regulations, coding guidelines, and billing requirements.

Problem Solving and Analysis:

• Identify trends in denials and payment issues and propose solutions to prevent recurrence.
• Work with other departments (e.g., billing, coding, registration) to resolve billing errors and process issues.
• Research and resolve complex billing inquiries from patients and insurance companies.

Mentorship and Training:

• Serve as a mentor and resource for junior AR Collections Agents.
• Assist in training new team members on collection procedures and systems.
• Provide guidance on handling difficult or complex accounts.

Reporting and Process Improvement:

• Prepare regular reports on AR status, collection rates, and key performance indicators (KPIs).
• Identify opportunities to improve collection processes and increase efficiency.
• Participate in team meetings and contribute to process improvement initiatives.

System Proficiency:

• Utilize billing software and other relevant systems to manage accounts and track collection activities (e.g., EPIC, Cerner, etc.).
• Maintain accurate and up-to-date information in the billing system.

Qualifications, Experience & Skills:

• Undergraduate degree or equivalent required; Associate's or Bachelor's degree in a related field preferred.
• Minimum of 5-7 years of experience in Phycian Billing/Hospital billing RCM AR collections.
• Proven track record of successfully collecting outstanding AR.
• Experience working with various insurance payers (e.g., Medicare, Medicaid, Commercial).
• In-depth knowledge of revenue cycle management
• Strong understanding of payer regulations and reimbursement processes.
• Excellent communication and interpersonal skills.
• Strong analytical and problem-solving abilities.
• Proficiency in using billing software and Microsoft Office Suite.
• Ability to work independently and as part of a team.
• Excellent organizational and time-management skills.
• Ability to handle a high volume of accounts and meet deadlines.

Preferred Qualifications:

• Experience with EPIC preferred but not mandatory
• Both Hospital and Professional billing experience preferred
• Flexible to work from Office all 5 days in the week in US shift