Gryphon Healthcare is a Houston-based revenue cycle management company serving healthcare providers nationwide. We pride ourselves on delivering results through accountability, transparency, and a hands-on approach, what we call “The Gryphon Difference.” Our team is collaborative, driven, and committed to supporting one another while delivering exceptional outcomes for our clients.
JOB SUMMARY
The Account Receivable Specialist is responsible for submitting claims, appeals of denied claims and working with commercial insurance carriers to ensure prompt accurate payment.
DUTIES AND RESPONSIBILITIES
Daily monitoring of denied claims in assigned billing system and re-processing the claims with correct demographic and coding information to ensure timely filing through the clearinghouse.
Follow-up on all denied claims to ensure payment from Insurance companies.
Utilize weekly Accounts Receivable work list to identify unpaid claims and follow-up with insurance carriers to re-process or appeal claims.
Initiate tracers with commercial insurance carriers to locate missing or lost payments.
Document all communication from insurance companies and patients pertaining to the claim status in billing system for tracking purposes.
Identify and communicate billing trends, including recurrent denials to the AR Manager, which increase accuracy in the billing process.
Provide support as needed, to all members of the billing and auxiliary departments at Gryphon Healthcare.
Stay abreast of current issues, trends and changes in the laws and regulations governing medical billing.
Demonstrates professional customer service standards when communicating with patients and insurance representatives on the phone or in email correspondence.
Maintains confidentiality of patient data and medical records in compliance with HIPAA guidelines and regulations.
Maintains a minimal claim resolution rate of 30 - 50 claims per day.
Performs other duties as assigned.
EDUCATION REQUIREMENTS
High School Diploma or equivalent required
EXPERIENCE REQUIREMENTS
2 years in medical billing preferred with the following detailed experience:
Knowledge of medical / billing collection practices
Knowledge of regulatory and payer requirements for reimbursement and reason(s) for denials by auditors.
Knowledge of basic medical coding and third-party operating procedures and practices
EMR, EDI and Commercial Insurance Company systems
PM Systems such as Collaborate and GoRev, including multiple clearinghouses and payments systems.
Out of Network (OON) negotiations, appeals and reconsiderations.
Ability to interpret and clearly explain out-of-pocket expenses, EOBs, and CARC/RARC codes to patients, carriers, and other callers.
Basic computer literacy includes keyboarding skills, Microsoft system (Outlook, Teams, Excel & Words) and the ability to navigate in a Windows environment.
Understands basic concepts of Excel spreadsheets for work queue.
Detail oriented, strong organizational skills and the ability to prioritize workload
Must demonstrate interpersonal skills with all levels of the billing and management team
Excellent oral and technical writing and typing skills.
Must be able to write and speak effectively in English
WORKING ENVIRONMENT
Onsite role in Gryphon’s Houston corporate office
Ability to sit, stand, and use office equipment for extended periods
Occasional lifting up to 20 lbs. (files, materials)
Ability to work in a fast-paced, high volume and dynamic environment.
Able to flex hours as needed to meet needs related to unanticipated volume, changes and/or problems.
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