AR Follow Up Specialist 

                                                                                                                          AR Follow Up Specialist 

USPI New Mexico Surgery Center - Orthopaedics is hiring a AR Follow Up Specialist 

Welcome to USPI New Mexico Surgery Center - Orthopaedics

No Weekends! No Call! Paid Holidays! 

At USPI New Mexico Surgery Center - Orthopaedics, we believe health and care are inseparable.  We focus on offering a high quality, service oriented environment for your surgical procedure.

Job Title: AR Follow Up Specialist 

Reporting Relationship: Reports to the Business Office Manager

Job Summary: An insurance A/R (Accounts Receivable) Follow-Up Specialist investigates and resolves unpaid or denied insurance claims to ensure proper payment and timely revenue cycle management. Key responsibilities include contacting insurance carriers on aged claims,
analyzing EOBs and claim denials for discrepancies, researching coding issues, resubmitting claims, appealing denials based on payer and government regulations, and maintaining detailed account notes. A strong understanding of medical coding, billing software, and insurance payer requirements is essential for success in this role.

Essential Duties and Responsibilities: Include the following. Other duties may be assigned.

• Claim Follow-Up: Proactively contact insurance companies for payment on aging,
  unpaid, or rejected claims.
• Denial Analysis: Investigate claim denials to identify coding errors, missing information,
  or payer issues.
• Corrections and Resubmissions: Correct inaccurate demographic information or coding
  and resubmit claims that were rejected or not received by the payer.
• Appealing Denials: Prepare and submit appeals for denied claims, often requiring the
  input of physicians or coders for supporting medical necessity language.
• Research and Problem Solving: Research network problems, work comp issues, and
  other complex claim issues to resolve them effectively.
• Documentation: Maintain detailed and concise notes on all account activities and
  communications with insurance carriers.
• Compliance: Ensure all actions adhere to federal, state, and payer-specific regulations
  and guidelines.
• Reporting: Generate reports to monitor A/R trends and identify patterns in claim denials
  to improve processes.
• Technical Skills: Proficiency with medical billing software, practice management
  systems, and payer websites is required.
• Analytical Skills: Ability to research, analyze, and interpret claim data and EOBs to
  resolve discrepancies.
• Communication Skills: Excellent verbal and written communication skills to interact with
  insurance carriers and internal teams.
• Knowledge: Strong understanding of medical terminology, coding (ICD-10, CPT), and
  the billing/appeals process for various commercial and government payers (Medicare,
  Medicaid, etc.).
• Critical Thinking: The ability to think critically and creatively to find solutions to complex
  billing issues.
• Education: While a high school diploma is the minimum requirement, many employers
  prefer candidates with an associate's or bachelor's degree in a related field.

Job Behavior: Reflective of Mission Statement:

USPI’s mission is to provide first–class surgical services for the local community in a safe, comfortable and welcoming environment; one in which we would be happy to treat our own families.

Demonstrates ability to work as a team member and to communicate directly and professionally. Is flexible, reliable, productive, patient-oriented, and self-motivated. Maintains professional conduct and appearance.

Language Skills: Ability to read and interpret documents and correspondence. Ability to write routine reports and correspondence, memos. Ability to communicate effectively with physicians, their staff, patients, and their families.

Physical Demands: The physical demands described here are representative of those that shall be met by the employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The employee shall occasionally lift and/or move up to 10 pounds.

What We Offer
As an organization, one way we care for our communities and each other is by providing a comprehensive benefits package that includes the following, subject to employment status:

• Medical, dental, vision, and prescription coverage
• Life and AD&D coverage
• Availability of short- and long-term disability
• Flexible financial benefits including FSAs and HSAs
• 401(k) and access to retirement planning
• Paid holidays and vacation

Who We Are
At USPI, we create relationships that create better care. We partner with physicians and healthcare systems to provide first-class ambulatory solutions throughout the United States. We are committed to providing surgical services in the most efficient and clinically excellent manner.

USPI is committed to, and proud of our inclusive culture. An inclusive culture, in our view, is respectful of differences and nurtures and supports the contributions of each individual, while also embracing and leveraging diversity. A diverse workforce, combined with an inclusive culture, makes USPI stronger and better able to meet the needs of our diverse patient and physician population.

USPI’S EDGE™ (Every Day Giving Excellence)

USPI’S EDGE™ is the key to the differentiation of USPI as a customer-focused company. The process of completing EDGE™ requirements establishes processes and measurements that are collected, assimilated, and shared throughout USPI. All employees are involved with EDGE™. The involvement can range from doing their jobs to taking on the role of gathering and/or entering data into the computer. All employees shall at some time during their employment be required to participate in the EDGE™ program.

KNOWLEDGE, SKILLS, QUALIFICATIONS and EDUCATIONAL and/or EXPERIENCE REQUIREMENTS:

• To perform this job successfully, an individual shall be able to perform each essential duty satisfactorily.
• The requirements listed are representative of the knowledge, skill, and/or ability require.
• High School education and/or equivalent; up to one year of related experience or training or equivalent combination of education and experience.
• Shall have demonstrated computer skills.