The Collections Specialist is responsible for ensuring correct, efficient and timely revenue procurement for all medical services billed by their assigned practice(s).

PRIMARY RESPONSIBILITIES:

Working within a centralized team and under the direction of the Senior Revenue Cycle Manager, focused attention to assigned accounts receivable include but are not limited to:

• Following up on claims from billing through final resolution.
• Verifying claims status with third-party medical insurance companies.
• Reviewing and preparing claims for electronic and hard copy appeals submission.
• Denial and Appeal Management on all payers’ claims.
• Identifying and correcting COB errors, rejections, and denials.
• Providing review of payer remittance advice for errors, denials, and under-payments.
• Acting cooperatively and courteously with patients, visitors, co-workers, and management to effectively resolve payment issues with insurance carriers.
• Supports the RCM manager and practice management by assisting with research of issues related to services provided and payer requirements.
• Other related duties as assigned by leadership team.

KNOWLEDGE/EXPERIENCE:

• Minimum of three years of medical billing experience preferably within a specialty physician practice.
• Knowledge of CPT, HCPCS and ICD coding.
• Proficiency in working medical claim accounts receivables.
• Proficiency with use of third-party insurance payer portals and Availity, etc.
• Proficiency in calling varied insurance plans to follow-up on claims processing.
• Skilled in MS Excel, Word, Outlook, and running calculations.
• Experience in providing co-workers, patients, providers, management team and other key stakeholders with support in a positive and efficient manner.
• High School Diploma or Equivalent.

Job Requirements:

• Effectively prioritize, multitask, and demonstrate an attention to detail.
• Communicate professionally and effectively with leadership, peers and other stakeholders to efficiently manage assigned accounts receivable.
• Protects confidential and protected patient health information and maintains strict confidentiality in accordance with HIPAA laws, regulations, and company’s policy.
• Presents a positive, professional appearance and conveys a pleasant demeanor in the performance of assigned duties.
• Embodies the values of the organization’s mission, vision, and core values always.
• Conducts business with respect for all individuals.
• Reads and complies with established organizational policies and procedures.
• Exemplifies the highest levels of quality and integrity aligned with the organization’s quality standards, policies, and procedures.
• Business telephone skills and ability to answer and transfer calls in a professional and timely manner.
• Able to accommodate flexible work hours to meet the needs of the business.
• Maintains awareness of potential safety hazards ensuring necessary safety precautions.

Working Conditions and Physical Requirements:

• Minimal physical effort.
• May require some lifting - up to twenty pounds.
• May require extended long periods of time sitting.
• Close vision, color vision, and ability to adjust focus are required.
• Moderate noise levels.
• Works in a clean, well-lighted and ventilated environment with no apparent exposure to physical and or chemical hazards.