Summary

Onsite

The accounts receivable collections specialist will be responsible for maintaining industry standards for the A/R they are assigned to for all carriers in regard to aging, collection rates, appeals, rejections and claims with no activity. This position will also post adjustments as needed and responsible for the follow up on all outstanding insurance claims. The collections specialist will work the aging reports as directed by the A/R Manager. Responsible for lowering A/R over 90 days to acceptable standards. This position is also responsible for timely follow-up with internal and external customers as well as third-party payers. Supports and adheres to all policies and procedures.

Essential Duties and Responsibilities

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Research claims and refile/appeal as necessary (phone, paper, or online) based on review of coding, contractual issues, data entry errors, etc.
• Monitor payer rejects and denials to determine systemic or data entry issues and report irregularities to management

• Daily follow up on all outstanding assigned insurance claims.
• Daily follow up on all claim reports generated based on rejections, appeals and denials by the insurance carriers.
• Post contractual adjustments and transfer deductibles to patient accounts based of correspondence from the insurance carriers.
• Assist with claim resubmission projects when necessary.
• Work with supervisors to streamline billing procedures based on denial types.
• Research and resolve unpaid claims.

• Correcting errors on daily basis

• Review accounts that have partial or under payments.
• Prepare spreadsheets on unpaid or partial pay claims for resubmission to payers.
• Handle correspondence from insurance companies including denials, information requests or refund requests.
• Handle incoming calls from patients and insurance companies regarding claims and patient balances.
• Review accounts to determine if billed correctly.
• Performs other related duties as assigned or described in Company policy.

Qualifications

• 3 years' experience in healthcare collections setting.
• 3 years' experience with Medicare, Medicaid, and Commercial carriers' collections
• Ability to read explanation of benefits (EOBs) is critical for this position
• Strong cognitive skills including analysis, problem solving, high attention to detail, and decision making
• Ability to work collaboratively with other team members to support data quality and integrity initiatives
• Great organizational skills
• Ability to work on multiple assignments concurrently within established timeframes
• Ability to multi-task, establish and meet deadlines
• Ability to work in fast-paced environment and maintain accuracy
• Strong verbal and written communication skills
• Ability to troubleshoot and recommend root cause solutions to problems
• Above average organizational and time management skills
• Strong Microsoft Office experience with emphasis on Excel (intermediate to advanced).
• Knowledge of Federal, state and HIPAA privacy regulations

Education/Experience:

• High School graduate or equivalent
• ACPC preferred but not required