This job is responsible for corresponding with health insurance payers to address and resolve outstanding insurance balances and non-coding denials in accordance with established standards, guidelines and requirements. An incumbent conducts follow-up process activities through phone calls escalations, fax and written correspondence, leveraging work queues to organize work efficiently. Work also includes reviewing insurance remittance advices, researching denial reasons and resolving issues through well-written appeals.

Responsibilities: 100% insurance follow-up.

Full job description

We are looking to expand collections team with a well-versed Collections Specialist with years of experience to take us to join our team and help us grow.

Under the guidance and supervision of the Collections Manager, you will be responsible for the collection of outstanding account receivables with insurance companies and all other aspects of collections, analysis, and resolution of billing problems, and reducing accounts receivable delinquency.

Essential Collection Specialist Responsibilities:

• Conduct collection calls and/or correspondence in a fast-paced goal-oriented collections department.
• Manage claims collections (not patient collections)
• Phone call escalations a the carriers level.
• Ability and experience overturning insurance denials.
• Ability to to write carrier and appeal and understanding contracts and guidelines.
• Resolve insurance discrepancies and short payments
• Contact and inquire with insurance companies for collection
• Document in detail problem/action/ and follow up with insurance companies until claim paid
• Possess working knowledge of Explanation of Benefits (EOB’s)
• Responsible for monitoring and maintaining assigned accounts
• Accountable for reducing delinquency for assigned accounts
• Verification of Refund Requests and Medical Records requests
• Provide timely reporting via creation and management of spreadsheets and updates to direct supervisor and/or Management Team
• Initiate and resolve Appeals for many different insurance payers.

Requirements:

• Minimum of 3 years insurance collections experience (at least 2 years of out-of-network collections experience)
• Have trained collections specialists in the past
• Very computer savvy and ability to quickly learn and utilize new billing systems, insurance portals, etc
• Well versed in Microsoft excel- weekly reports will be sent to the owner via excel
• Great communication skills
• Ability to work well with a team and share knowledge amongst the staff

ESSENTIAL KEY JOB RESPONSIBILITIES

1. Follows-up with insurance payers to research and resolve unpaid insurance accounts receivable; makes necessary corrections in the practice management system to ensure appropriate reimbursement is received.

2. Applies a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices, including when and how to ensure that correct and appropriate payment has been received.

3. Communicates effectively over the phone and through written correspondence to explain why a balance is outstanding, denied and/or underpaid using accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements.

4. Resubmits claims with necessary information when requested through paper or electronic methods.

5. Anticipates potential areas of concern within the follow-up function; identify issues/trends and conducts staff training to address and rectify

6. Recognizes when additional assistance is needed to resolve insurance balances and escalates appropriately and timely through defined communication and escalation channels.

7. Resolves work queues according to the prescribed priority and/or per the direction of management and in accordance with policies, procedures and other job aides.

8. Assists with unusual, complex or escalated issues as necessary.

9. Organizes open accounts by denial type or payer to quickly address in bulk with representatives over the phone, via spreadsheet, etc.

10. Accurately documents patient accounts of all actions taken in the billing system.

Job Type: Full-time

Pay: $28.00 - $34.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Employee discount
• Flexible schedule
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Application Question(s):

• Required Hourly Rate?
• Able to commute daily to Lower Manhattan?

Experience:

• Insurance Follow-up: 3 years (Required)
• Denial Management: 3 years (Required)
• Insurance Claims Appeals: 3 years (Required)

Work Location: In person