AR Specialists

How to become an Accounts Receivable Specialist?

Accounts Receivable Specialists, also known as AR Callers, are professionals in the healthcare industry who keep track of medical claims/bills from insurance companies and patients. In addition, they follow up on partial and pending payments for medical claims/bills.

What does an Accounts Receivable Specialist do?

The functions of an Accounts Receivable Specialist include:

Analyze: AR specialists thoroughly analyze a client’s information before making calls to insurance companies and patients.

Call: They make calls to insurance companies and patients on behalf of physicians and check the status of payments/claims.

Prioritize: AR specialists prioritize payments/claims that have been outstanding for a more extended period.

Update: They update client documentation regularly and send the documents to insurance companies for future reference.

Assess: AR specialists assess requests and complaints to ensure the inquiries resolve within a short time.

Accounts Receivable Specialist requirements

AR Specialists need to meet specific requirements. Listed below are a few of them:

• AR Specialists must have excellent English communication skills.
• They should have a basic knowledge of computers.
• Willingness to work the night shift is a must.
• Prior experience working in medical billing will be preferred.
• It is also preferred for AR specialists to know ICD/CPT codes.

Education

A graduate degree from a recognized university is eligible for the position of AR specialist. No specific degree is needed to become an AR specialist. Training in AR calling is essential.

Training

Many companies and institutes offer training programs for AR calling. The duration of these programs differs from company to company. Nevertheless, most training programs span between one to three months.

MedConverge also offers training programs in AR Calling, Medical Coding, Medical Billing, Interview Skills, and Personality Development and Soft Skills. Click here to check out the details.

Certifications

American Medical Billing Association (AMBA) and AAPC are the two leading organizations that offer Medical Coding and Billing certifications.

AMBA

It is an organization dedicated to Medical Billing. It offers certification through the Certified Medical Reimbursement Specialist (CMRS) exam, a comprehensive exam.

About the exam

It has 694 questions divided into 16 sections. Each section has a varied number of questions and covers all phases of the medical billing process.

The exam result is available upon completing the examination, and the certificate is emailed immediately. The hard copy of the certification takes about 3 to 4 weeks to arrive.

This certificate is valid for one year from the date of completion of the exam. AMBA issues a certificate every year after completing the recertification process.

Those who do not pass the examination are allowed three free retakes with a minimum of 30 day waiting period between each retake.

Requirements for the exam

Must be a member of AMBA: The individual must already be a member of AMBA to take the exam.

Access to current year’s codes: The individual must have access to all the current year’s codes like CPT, ICD-10, and HCPCS.

Prior knowledge: The individual must have prior experience in medical billing or at least have knowledge of the same.

A high school diploma or equivalent: Individuals must have at least a high school diploma or something equivalent to sit for the exam.

Requirements for renewal

Obtain continuing education units (CEUs): Each year, the individual must attain 15 CEUs. One can obtain them for free by completing AMBA webinars. Other organizations like AAPC, AHIMA, PMI, and MGMA also offer continuing education credits.

AAPC

Previously known as the American Association of Professional Coders, this organization primarily focuses on medical coding, also offering medical billing certification. AAPC offers Medical Billing certification upon completing the Certified Professional Biller (CPB) exam.

About the exam

The exam comprises 200 multiple choice questions divided into seven sections. They are:

• Types of insurance
• Billing regulations
• Reimbursement and collections
• HIPAA and compliance
• Coding
• Billing
• Case Analysis

The exam will also focus on the interaction of medical billers with insurance payers. The time duration to complete the exam is 5 hours and 40 minutes.

Individuals need an overall score of at least 70% to pass the exam. Those who fail to pass their first attempt are allowed one free retake within one year of the first attempt. 

Requirements for the exam

A degree: AAPC recommends those who take the exam have an associate’s degree.

Member of AAPC: Individuals should have an AAPC membership.

Prior knowledge: It is advised for individuals to have prior knowledge of the entire medical billing process.

Requirements for renewal

Each year, the individual must attain 15 CEUs. One can obtain themfor free by completing AMBA webinars. Other organizations like AAPC, AHIMA, PMI, and MGMA also offer continuing education credits.

Obtain continuing education units (CEUs): The AAPC certification requires 36 CEUs every two years to stay certified. One can acquire these by attending webinars or workshops. Other organizations like AHIMA, PMI, and MGMA also offer continuing education credits.

NHA

National Healthcareer Association (NHA) is a professional certification organization in the United States of America. It offers certification upon completing the Certified Billing and Coding Specialist (CBCS) exam.

About the exam

The exam consists of 100 questions which are divided into four sections:

• Revenue Cycle and Regulatory Compliance
• Insurance Eligibility and Other Payer Requirements
• Coding and Coding Guidelines
• Billing and Reimbursement

The duration of the exam is 2 hours. The results will be released two days (two weeks for those who attempt the written exam) after completing the exam. Individuals must score above 390 out of 500 to pass the exam.

Requirements for the exam

An individual taking the CBCS exam must have a high school diploma or something equivalent. They should have completed a medical coding or billing program within the last five years or have one year of work experience in the same field within the previous three years.

Requirements for renewal

The certification must be renewed every two years, and the individual must obtain 10 CEUs every two years to stay certified. NHA provides CE courses that are free for those who have certification.

Those whose certification has expired have one year to reinstate it.

Skills

AR specialists should be well-equipped with specific skills. Some of them are:

• Excellent communication skills
• The ability to multitask
• Strong reporting skills
• The ability to follow instructions
• Organizational skills
• The ability to work on an established schedule
• Punctuality of follow-up on claims
• The ability to work in a team
• Good management skills
• An understanding of client requirements
• An understanding of the Medical Billing Cycle

Example of AR Specialist Job Description

At MedConverge, we rely on powerfully insightful data to ensure the delivery of our excellent healthcare services.

As an AR caller, you will be responsible for making calls to insurance companies to follow up on pending claims.

We are looking for people with excellent spoken English skills, preferably with experience in account receivables and denial management processes.

Responsibilities

Pre-call analysis: An AR specialist should perform pre-call analysis. They should also call the payer or use web portal services to check the status of payments and claims.

Maintain documentation: AR specialists must maintain adequate documentation on client software and send the necessary documents to the insurance company.

Post-call analysis: AR specialists should perform a post-call analysis of the claim follow-up.

Follow up with payer: AR specialists should follow up and check the claims status after the call.

Follow up with provider: AR specialists must follow up on any unclear or insufficient documentation.

Perform analysis: AR specialists must analyze AR data and understand the reasons for underpayment, reasons for denial, use of appropriate codes, or errors in documentation.

AR specialists can later delve into comprehensive Revenue Cycle Management (RCM). They can further achieve proficiency in RCM.

The next step is becoming a specialist or a Subject Matter Expert (SME). Followed by either Team Leader, Quality Analyst, or Business Intelligence Expert.

Contact us to know more about Accounts Receivable job opportunities.