The Collections Specialist manages and collects on accounts receivables for insurance carrier plan services to meet departmental cash goals. They are responsible for researching payment issues, correcting claims, and verifying insurance eligibility to ensure timely reimbursement.
Job Requirements
Position Summary
The Collections Specialist is responsible for managing and collecting on accounts receivables for all insurance carrier plan services billed through the hospital/physician billing systems. This position is responsible for timely and accurate claims follow up and payer corrections to meet and exceed our departmental cash collection and AR goals.
Minimum Requirements
Education
Highs School Diploma or equivalent
Experience
3+ years medical office or medical billing/collections experience in a hospital or centralized billing setting.
Must possess knowledge of CPT, HCPCS, and ICD-9/10 codes.
Must have a good working knowledge with insurance explanation of benefits (EOB) and comprehensive understanding of remittance and remark codes.
Be familiar with multiple payer requirements for claims processing
Solid skills with Microsoft office with a focus on Excel and Word.
Good Communication Skills
License/Registration/Certifications
N/A
Preferred Requirements
Preferred Education
Associates degree
Preferred Experience
4+ years’ experience in a centralized billing setting.
Possess an in-depth working knowledge and experience with all types of insurance billing guidelines: Commercial, Medicare Part A and B, Medicaid, Managed Care plans etc.
Experience with multiple specialty billing, collections, and denials
Preferred License/Registration/Certifications
N/A
Core Job Responsibilities
Collections of all outstanding claims by direct payer contact, utilization of payer websites, and EDI/Claims system
Research and resolve all payments issues/errors for insurance balances
Responsible to complete all error corrections and insurance updates to the facility/professional claim to resolve issues preventing payment
Ability to obtain insurance eligibility and benefit information from payers via phone, RTE, or web for proper claims filing
Review smart edits and payer rejections and perform all necessary rework for reimbursement of services
Must possess the ability to work in different systems including claims eligibility, online payer claims system, as well as all AR management systems
Escalating non-denial payer issues, including review of outstanding AR greater than 90 days, and sharing details with payers and management
Work closely with multiple departments to obtain necessary information to resolve outstanding AR
Update and verify insurance records as needed to correct outstanding accounts
Responsible for ensuring claim has been received and is processing with payer within the timely filing period as defined by departmental goals and insurance guidelines
Ability to present trends and issues to payers during monthly provider calls
Gather information from payers to submit payment research requests when payment is not posted to an account
Produce reports and data in Excel as needed
Must have working knowledge of registration, payment posting, error correction and other billing functions
Exhibit professionalism and good customer service skills
Ability to maintain confidentiality and handle sensitive information
Responsible for responding to emails within 24/48-hour turnaround time from receipt
Responsible for utilization of time and management of work processes to ensure organizational and departmental expectations are met
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