• Accounts Receivable Representative Senior are primarily responsible for analyzing higher volume collections, resolving non-payables, and handling bill inquiries for more complex issues. The AR Specialist Senior will work closely with the AR Manager to make sure client’s accounts receivables meet Ventra Health standards. Must be able to operate in a team environment that strives to provide superior service to Ventra Health clients throughout the country. Complies with all applicable laws regarding billing standards.

• Assists in training for new hires and performing quality assurance for AR Reps
• Supports the RCM in identifying trended payer problems, generating associated work lists, and by being a resource for AR Representatives to answer questions and deliver a cohesive and positive work environment
• Identifies potential write-offs and/or adjustments and escalates to manager, as necessary
• Communicate with Provider Relations Reps and assists with payer projects
• Provide accurate and timely feedback on BPO issues or errors to RCM
• Research and follow up on all assigned insurance claims to ensure appropriate reimbursement for our clients
• Reviews coding, products, payment agreements, fee schedules, and/or authorization terms to facilitate resolution of open receivables
• Properly notates patient accounts and check system for missing payments
• Communicates with insurance companies for status on outstanding claims
• Review accounts to determine appropriate follow-up action (adjustments, letters, phone insurance, etc)
• Scan correspondence and index to the proper account
• Makes outbound calls to verify patient and insurance information
• Route client calls to the appropriate RCM
• Respond to insurance company claim inquiries
• Communicates with insurance companies for status on outstanding claims
• Meet established production and quality standards as set by Ventra Health
• Performs special projects and other duties as assigned

• High School Diploma or GED
• At least two to four (2-4) years in medical billing and claims resolution experience preferred
• AAHAM and/or HFMA certification preferred
• Experience with offshore engagement and collaboration desired

• Demonstrated ability to resolve complex claim issues, identify trends and provide resolution
• Expert level knowledge of medical billing rules, such as coordination of benefits, modifiers, Medicare, and Medicaid and understanding of EOBs
• Become proficient in use of billing software within 4 weeks and maintain proficiency
• Ability to read, understand, and apply state/federal laws, regulations, and policies
• Ability to communicate with diverse personalities in a tactful, mature, and professional manner
• Ability to remain flexible and work within a collaborative and fast paced environment
• Basic use of computer, telephone, internet, copier, fax, and scanner
• Basic touch 10 key skills
• Basic Math skills
• Understand and comply with company policies and procedures
• Strong oral, written, and interpersonal communication skills
• Strong time management and organizational skills
• Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills

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