Job Title: Accounts Receivable Specialist

Department: Accounts Receivable

Reports to: AR Supervisor

FSLA Status Non-Exempt

Prepared: May 2007

Revised: January 2024

SUMMARY

Specialist will ensure that all collection policies and procedures are applied to achieve timely collection of outstanding accounts receivables. They will interact with insurance companies via portal and over the telephone in an attempt to secure payment on receivables by performing the following duties:

DUTIES

- Interacts with insurance companies over the telephone, through the mail, email, or fax to resolve issues in regards to collections on accounts.
- Collects outstanding balances by reviewing incoming correspondence and aging reports.
- Analyze denials and correspondence then prepare and process an appeal for additional payment.
- Claim resubmittals.
- Submittal of medical records, LMNs or other requested information in order to satisfy a claim response.
- Forward accounts for adjustments/write-offs and inactivation with appropriate supporting documentation.
- Placing accounts on hold pursuant to information received to avoid any future loss.
- Reviews collection hold reports and audits accounts to resolve any outstanding issues with patients or insurance companies to determine next course of action.
- Meeting designated monthly production and collection goals.
- Updating system with notes, physician information, diagnosis codes, and any other pertinent information required for payment.
- Using carrier resources (web links) to obtain patient claim and coverage information.
- Identifying individual carrier policies, as well as how and why a carrier pays or denies claims.
- Work special projects as assigned

Understand, support and comply with policies, procedures and internal controls in accordance with the best business practices across the organization.

EDUCATION AND/OR EXPERIENCE

High school graduate or equivalent; 2 or more years of medical collections experience preferred; knowledge of managed care process; experienced using data processing software and 10 key abilities; or equivalent combination of education and/or experience.

I have read, understood and agree with the contents of my . I also understand that this is subject to change or modification without prior notice in order to meet evolving business requirements and/or needs.

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Employee Signature Date

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Employee Print Name

Recommendation: Higher Proficiency Agents for the Pilot Program

This international process, which will go on to become a showcase to this as well as other international clients, particularly in the area of accounts receivables and insurance collections, requires agents with higher proficiency levels for several critical reasons:

1. Complex Problem-Solving: Higher proficiency agents possess the advanced analytical skills necessary to navigate complex issues, such as denials and appeals. Their ability to quickly understand and resolve intricate problems ensures smoother and more effective operations during the pilot phase.
2. Effective Communication: Proficient agents excel in communication, essential for interacting with insurance companies, patients, and internal teams. Their ability to articulate issues clearly and professionally helps build strong relationships and facilitates successful collections.
3. Adaptability and Learning: A pilot program often involves new procedures and technologies. Agents with higher proficiency can quickly adapt to these changes and learn new systems, ensuring minimal disruption and maximum efficiency.
4. Goal Achievement: Meeting designated monthly production and collection goals is crucial for evaluating the pilot programs success. Proficient agents are more likely to achieve these targets due to their experience and skill set, providing reliable data for assessing the program's effectiveness.
5. Attention to Detail: The ability to meticulously review and update systems with accurate information is vital. Higher proficiency agents demonstrate exceptional attention to detail, reducing errors and ensuring that all necessary documentation is correctly processed.
6. Initiative and Proactivity: Proficient agents often show greater initiative, proactively seeking solutions to improve processes and outcomes. Their proactive approach can drive the pilot program's success, leading to innovations and efficiencies that benefit the entire organization.
7. Stress Management: Pilots can be high-pressure environments requiring agents to manage stress effectively. Agents with higher proficiency levels are typically more resilient, maintaining productivity and a positive attitude under pressure.

Mentioned below are the technical, functional and behavioral competencies alongwith the recommended proficiency rating. Competency Table for AR Specialist Role (Pilot Batch)

Competency TypeCompetency DescriptionProficiency Rating (1-5)TechnicalKnowledge of insurance company portals and telecommunication methods4 Proficiency in claims resubmittals and medical records handling4 Familiarity with diagnostic codes and insurance policies3 Ability to use collection and accounting software3 Data entry and updating systems with pertinent information3FunctionalTimely collection of outstanding accounts receivables4 Analyze denials and prepare/process appeals4 Forwarding accounts for adjustments/write-offs with supporting documentation3 Reviewing collection hold reports and auditing accounts3 Meeting monthly production and collection goals4 Understanding and compliance with policies and internal controls3BehavioralEffective communication with insurance companies through various channels4 Problem-solving and critical thinking to resolve collection issues4 Attention to detail in handling and processing claims and correspondence4 Collaboration and teamwork to support new and existing team members3 Adaptability to work on special projects and handle changing priorities3 Initiative in securing payments and managing receivables4 Maintaining a positive and professional attitude under pressure4CommunicationEnglish Speaking Fluency4 English Writing Proficiency4 Mother Tongue Influence 4

Competency Weightage Grid To ensure a comprehensive evaluation of candidates, the competencies can be weighted according to their importance to the role. Here's an example of a weightage grid for technical, functional, behavioral, and communication competencies:

Competency TypeWeightage (%)Average RatingWeighted ScoreOverall RatingTechnical20% Functional30% Behavioral20% Communication30% Competency Assessment Rating Grid

Rating Scale

1. Unsatisfactory: Candidate does not demonstrate competency at an acceptable level.
2. Needs Improvement: Candidate shows some understanding but lacks proficiency or experience.
3. Satisfactory: Candidate demonstrates basic competency and adequate experience.
4. Good: Candidate shows strong understanding and good level of proficiency.
5. Excellent: Candidate exhibits exceptional skill and extensive experience.

Candidate Acceptance Rating Grid

Rating Levels

Total Score RangeRatingDecision3.5 - 5.0HireStrong candidate with excellent competencies, proceed with hiring.3.0 - 3.4HoldCompetent candidate with potential, consider for the role if no stronger candidates are available.Below 3.0RejectDoes not meet the required competency level, do not proceed with hiring.Sample Scoring

Competency TypeWeightage (%)Average RatingWeighted ScoreOverall RatingTechnical20%3.00.603.65Functional30%4.01.2Behavioral20%4.00.80Communication30%3.51.05

Technical Competencies

1. Knowledge of insurance company portals and telecommunication methods

- Question: Describe your experience with using insurance company portals and telecommunication methods for resolving account issues. Can you provide an example of a challenge you faced and how you overcame it?

Rating Grid: RatingDescription1No relevant experience2Limited experience with insurance portals and methods3Adequate experience, some challenges faced4Strong experience, effectively resolved challenges5Extensive experience, exceptional problem resolution

1. Proficiency in claims resubmittals and medical records handling

- Question: How do you handle claims resubmittals and the submission of medical records? Can you walk us through a specific case where your actions led to a successful claim resolution?

Rating Grid: RatingDescription1No relevant experience2Limited experience with claims and medical records3Adequate experience, successful claims handled4Strong proficiency, several successful claim resolutions5High proficiency, consistently successful claim outcomes

1. Familiarity with diagnostic codes and insurance policies

- Question: How familiar are you with diagnostic codes and insurance policies? Can you provide an example of how you applied this knowledge in a past role?

Rating Grid: RatingDescription1No knowledge of diagnostic codes or policies2Basic knowledge, minimal application3Adequate knowledge, some practical application4Strong knowledge, regular application in past roles5Expert knowledge, extensively applied in various contexts

1. Ability to use collection and accounting software

- Question: What collection and accounting software have you used in previous roles? Can you describe how you used these tools to improve your workflow?

Rating Grid: RatingDescription1No relevant software experience2Limited experience with collection/accounting software3Adequate experience, basic improvements to workflow4Strong experience, significant workflow improvements5Extensive experience, exceptional workflow optimization

1. Data entry and updating systems with pertinent information

- Question: Describe your approach to ensuring accurate data entry and updating systems with necessary information. What steps do you take to minimize errors?

Rating Grid: RatingDescription1No relevant experience2Inconsistent accuracy, frequent errors3Adequate accuracy, occasional errors4High accuracy, minimal errors5Exceptional accuracy, consistently error-free

Functional Competencies

1. Timely collection of outstanding accounts receivables

- Question: How do you prioritize and manage your tasks to ensure the timely collection of outstanding accounts receivables?

Rating Grid: RatingDescription1No relevant experience2Frequently misses deadlines3Meets deadlines, occasional delays4Consistently meets deadlines5Always meets or exceeds deadlines

1. Analyze denials and prepare/process appeals

- Question: Can you describe a time when you successfully analyzed a claim denial and prepared an appeal that led to additional payment?

Rating Grid: RatingDescription1No relevant experience2Limited success in preparing appeals3Adequate success, occasional successful appeals4Strong success, frequent successful appeals5High success rate, consistently successful appeals

1.



Forwarding accounts for adjustments/write-offs with supporting documentation

- Question: What process do you follow when forwarding accounts for adjustments or write-offs? How do you ensure all supporting documentation is accurate and complete?

Rating Grid: RatingDescription1No relevant experience2Limited understanding of process3Adequate process understanding, occasional errors4Strong process adherence, minimal errors5Exceptional process execution, consistently accurate

1. Reviewing collection hold reports and auditing accounts

- Question: Explain your method for reviewing collection hold reports and auditing accounts. How do you determine the next course of action?

Rating Grid: RatingDescription1No relevant experience2Inconsistent review/auditing methods3Adequate review methods, occasional issues4Strong review methods, minimal issues5Highly effective review/auditing, consistently accurate

1. Meeting monthly production and collection goals

- Question: How have you consistently met your monthly production and collection goals in previous roles? What strategies do you use to stay on track?

Rating Grid: RatingDescription1Frequently misses goals2Occasionally meets goals3Adequately meets goals4Consistently meets goals5Always exceeds goals

1. Understanding and compliance with policies and internal controls

- Question: How do you stay updated on policies and internal controls? Can you provide an example of how you ensured compliance in a past role?

Rating Grid: RatingDescription1No relevant understanding2Limited understanding, occasional non-compliance3Adequate understanding, mostly compliant4Strong understanding, consistently compliant5Expert understanding, ensures full compliance

Behavioral Competencies

1. Effective communication with insurance companies through various channels

- Question: How do you ensure effective communication with insurance companies via phone, email, and other channels? Can you share an example of a successful interaction?

Rating Grid: RatingDescription1Ineffective communication2Limited communication skills3Adequate communication skills4Strong communication skills5Exceptional communication skills

1. Problem-solving and critical thinking to resolve collection issues

- Question: Describe a complex collection issue you encountered and the steps you took to resolve it. What was the outcome?

Rating Grid: RatingDescription1Poor problem-solving skills2Limited critical thinking3Adequate problem-solving skills4Strong problem-solving and critical thinking5Exceptional problem-solving skills

1. Attention to detail in handling and processing claims and correspondence

- Question: How do you ensure accuracy and attention to detail when processing claims and correspondence? Can you provide an example of a time when this attention to detail was crucial?

Rating Grid: RatingDescription1Frequently overlooks details2Occasionally misses details3Adequate attention to detail4Strong attention to detail5Exceptional attention to detail

1. Collaboration and teamwork to support new and existing team members

- Question: Can you describe a situation where you worked collaboratively with your team to support a recent member or achieve a common goal?

Rating Grid: RatingDescription1Poor teamwork and collaboration2Limited collaboration3Adequate collaboration4Strong teamwork and collaboration5Exceptional teamwork and collaboration

1. Adaptability to work on special projects and handle changing priorities

- Question: How do you handle changing priorities and adapt to special projects? Can you share an example of a time when you had to quickly adapt to a new situation?

Rating Grid: RatingDescription1Resists change2Struggles with adaptability3Adequate adaptability4Strong adaptability5Exceptional adaptability

1. Initiative in securing payments and managing receivables

- Question: Give an example of how you took the initiative to secure a payment or improve the management of receivables in a previous role.

Rating Grid: RatingDescription1No initiative demonstrated2Limited initiative3Adequate initiative4Strong initiative5Exceptional initiative

1. Maintaining a positive and professional attitude under pressure

- Question: How do you maintain a positive and professional attitude when under pressure? Can you share a specific example where you demonstrated this quality?

Rating Grid: RatingDescription1Poor attitude under pressure2Occasionally struggles under pressure3Adequate attitude under pressure4Strong attitude under pressure5Exceptional attitude under pressure

English Speaking, Writing, and Mother Tongue Influence Competencies

1. English Speaking

Rating Grid: RatingDescription1Poor English speaking skills2Basic English speaking skills, struggles with fluency3Adequate English speaking skills, minor issues4Strong English speaking skills5Excellent English speaking skills, highly fluent

1. English Writing

Rating Grid: RatingDescription1Poor English writing skills2Basic English writing skills, frequent errors3Adequate English writing skills, occasional errors4Strong English writing skills, minimal errors5Excellent English writing skills, clear and error-free

1. Mother Tongue Influence (MTI)

Rating Grid: RatingDescription1Strong MTI, frequently impacts clarity2Noticeable MTI, sometimes impacts clarity3Moderate MTI, occasionally impacts clarity4Minimal MTI, rarely impacts clarity5No noticeable MTI, clear and neutral accent

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