In healthcare organizations, the AR management function is getting more and more complex due to ICD-10 coding requirements, the Affordable Care Act, and the need to manage relationships with many payors, both government and commercial as well as patients/guarantors. The consequence is a growing need for AR specialists to deal with it all. It is their mission is to make sure that revenues for services billed come in as expected and are not lost while maintaining patient service excellence.
Typical Medical AR Specialists include:
- Medical Billing Specialist: Handles day-to-day billings, maintains and grows payor relationships, and ensures optimal billing processes. Depending on the volume of billings, this may also involve specialists in Medicare and Medicaid Follow-up as well as Commercial Payor Follow-up.
- Medical Claims Denial Specialist: Identifies root causes of insurance denials, sends appeals to payors, and strives to minimize lost revenue. (a.k.a. Denial Resolution Specialists, Claim Submission Resolution Specialist)
- AR Resolution/Collections Specialists: Collaborates with consumers and insurance representative to resolve outstanding obligations in a fair and timely manner.
- Medical Patient Collections Specialists: Collects patient liabilities that occur when patients are uninsured or have deductibles and coinsurance due. They may assist patients with setting up payment plans or refer them to eligibility professionals to explore additional reimbursement resources. With the recent increase in patient liabilities, this role is increasingly important.
- Patient Access Representative: Acquires and records demographic and reimbursement data for use in patient care, medical record and revenue cycle activities. Accurate and complete registration is critical for obvious reasons. It is important to recognize that patients form first and lasting impressions based on their encounters with access representatives so customer service orientation is critical.
A Highly Customized Approach
Depending on the specific challenges presented by client facilities, organization structure and technology, the areas of specialization summarized above may overlap with each other or other areas of the revenue cycle:
- Medical Billing/Collections Specialist
- Medical Claims Resolution & Collections Specialist
- Medical Coders/Billers
Other duties that may be part of the responsibilities of an AR Specialist, or in a large hospital be an area of specialization are:
- Credit Balance Resolution
- Cash Applications
- Customer Service
In any case, Nearterm recognizes the importance of role definition and the chemistry that must exist for people to work together successfully. It is our practice and our commitment to design and fine-tune resource solutions that make sense for you.
As a Medical Accounts Receivable Managed Services Provider, Nearterm can provide clients with AR Specialist services, remote or onsite, as part of a 360° Managed RCM Services solution.
As a “Managed Service,” our Medical AR Specialists are professionally managed and their performance is measured by a Nearterm Partner in Charge (PIC). This is to ensure that they meet the service level quality requirements agreed upon with the client, as expressed in our Q100=Quality Assurance program.