PFS Collection Specialist

Position Summary:
Responsible for collecting commercial, government, and patient balances by following the approved processes, policies and procedures set by the revenue cycle department.

Remote position

Essential Functions:

• Monitors outstanding account balances to determine the next step in the collection process.
• Follows up on claims and claim denials to ensure maximum reimbursement for services provided.
• Reviews accounts receivable activities and calls on outstanding balances or claims.
• Generates appropriate paperwork, including insurance claim forms (original and re-filed) and collection letters.
• Reviews insurance payments (Explanation of Benefits – EOB’s) to determine whether reimbursement is accurate. Navigate portals to send claims for adjudication.
• Investigates and appeals denied or underpaid claims.
• Responds to all inquiries received from patients and payors either by telephone or written request.
• Tracks and resolves discrepancies.
• Follows-up on unpaid insurance claims after denial to obtain settlement of claim.
• Audit insurance and patient accounts to determine whether a refund is needed.
• Promptly and courteously responds to all inquiries received from payors and patients either by telephone or written request.
• Provides clear communication and customer service on collection issues to external customers and internal business partners.
• Helps patients develop patient payment plans.
• Identifies patterns and trends that indicate a potential issue.
• Adheres to all policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.
• Performs other duties that may be necessary or in the best interest of the organization.
• Submits billing data to insurance providers.
• Participates in continuing educational activities relative to assigned duties and responsibilities.

Qualifications/Skills:

• High school diploma or GED required.
• Computer proficiency and experience in windows-based technologies
• Ability to be discrete and security confidential and sensitive information.
• Prior work experience in a medical office setting preferred.
• Excellent problem-solving skills, attention to detail, management of multiple tasks and the ability to do so independently.
• Ability to handle difficult situations with a positive attitude.
• Good interpersonal, oral and written communication skills.
• Strong organizational and time management skills.
• Ability to adhere to deadlines timely.
• Must be able to work as part of a team with peers and leadership within the organization.
• Must possess a high level of interpersonal skills including the ability to respond calmly and make rational decisions in stressful situations.