Pain Specialists of America

Accounts Receivable

• Review and research claims denials and contact payers to verify detailed denial reasons when necessary
• Contact patients to obtain accurate insurance information
• Prepare documentation and file reconsiderations and appeals as appropriate
• Identify and communicate denial/rejection trends to management
• Identify and resolve discrepancies
• Navigate and research insurance policies and benefits for policy exclusions
• Navigate and research payer medical reimbursement policies and exclusions
• Review and work all daily correspondence received from patients and payers
• Understand and act on timely filing guidelines associated with claims filing, reconsiderations, and appeals for assigned payers
• Review accounts for accuracy, including payments and adjustments
• Work with medical EOBs, patient deductibles and copays, and insurance or third-party correspondence
• Work with payer websites
• Work aged AR EDI transactions and troubleshoot issues
• Perform other assigned duties

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AR Specialist

General

• Verify eligibility and benefits by coordinating with patients’ medical coverage to ensure coverage is active and obtaining plan benefits relevant to the practice
• Input payor demographic data into the EHR system
• Submit requests for referrals and authorizations for office visits, procedures, and DME
• Follow up with payors to ensure scheduled patients have all items required to secure reimbursement
• Communicate with surgery scheduling regarding authorization request status
• Create and distribute cost estimates for scheduled procedures based on obtained benefits
• Assist with incoming cost inquiries

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Authorization Coordinator

Human Resources

• Maintain employee and applicant documentation as required by governing agencies
• Manage and track employee disciplinary actions; coach and counsel managers before disciplinary actions
• Process unemployment notices and attend hearings when necessary
• Assist with recruitment, including application review and interviews
• Administer HR plans, procedures, policies, the employee handbook, and procedures manual
• Monitor tardiness, absenteeism, leave usage, performance evaluations, and salary adjustments
• Maintain personnel files, organization charts, employee directory, and HRIS records
• Ensure compliance with USCIS Form I-9 requirements and employment and benefits laws
• Manage workers' compensation case files and employee benefits eligibility, enrollment, cancellations, and changes
• Organize annual open enrollment communications and elections; administer COBRA
• Coordinate employee recognition programs
• Communicate HR policies, procedures, laws, standards, and regulations to employees and management
• Conduct exit interviews and recommend corrective actions and continuous improvements
• Respond to employee relations issues, harassment allegations, and civil rights complaints
• Facilitate employee training and orientation
• Investigate and settle grievances and participate in administrative meetings and seminars
• Evaluate department reports and recommend approaches to improve efficiency and services

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