Job Summary 

The Accounts Receivable Collection Specialist’s purpose is to process medical billing claims, collect patient or provider payments, resolve questions and problems with a customer’s accounts, process patient refunds, appeals to include re-determinations and resubmissions of billing to patient payers for payment on medical supply orders

Job Responsibilities:

• Generate timely billing of assigned payers
• Ensure claims are received and processed by payers
• Review A/R balances to ensure timely and accurate payments are received
• Maintain current and accurate computer data including documentation of all account activity performed in A/R systems
• Bill all co-insurance accounts per payer specific guidelines
• Complete cash logs as required
• Review and understand correspondence received from third party payers including remittance advices, Explanation of Benefits, denial letters, etc.
• Receive payment denials and to investigate the reason and rectify the situation with the payer or patient
• Receive inbound and place outbound calls from and to customers, Medicare, Medicaid and Commercial insurance providers regarding patient accounts
• Provide written correspondence to audit requests to include investigation and obtaining of appropriate documentation to be attached to response
• Document status of billing and payment process in patient account for future follow-up keep current on payer requirements via research and coaching to ensure guidelines and procedures are being met for each payer
• Answer and follow up on calls from patients with billing questions complete all end of month reports as requested, directed or assigned complete all internal system service ticket requests as assigned
• Work miscellaneous projects and tasks on an as needed basis

Job Qualifications:

• Education and Work Experience:
  • Minimum of five (5) years medical insurance/healthcare billing and collections experience with a deep understanding of medical billing rules and regulations.
  • Thorough understanding of medical billing, collections and payment posting, revenue cycle, third-party payers, Medicare; Medicare Advantage strong knowledge of state and Federal payer regulations
  • Minimum five years of direct supervision of 12 or more staff.
  • Well versed in CPT and ICD10 codes and procedural modifiers, claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits and appeal processes.
  • Strong leadership, team development and business skills.
  • Solid understanding of billing software and electronic medical records (EMR) eCW experience preferred.
  • Must be Bilingual in English/Spanish
• Certificates and Licenses:
  • Valid Driver License
  • Certified Coder a plus

• Skills:

  • Computer Literacy
  • Customer Service and Relations
  • Diplomacy
  • Math Aptitude
  • Oral Communication
  • Organizational Management
  • Planning
  • Time Management
  • Written Communication

BENEFITS

• Comprehensive benefits package, including Health, Vision, Dental, and Life insurances
  • FSA and Life Assistance Program (EAP)
  • 401(k) Retirement Plan
  • Health Advocacy, Travel Assistance, and My Secure Advantage
• PTO Accrual and Holidays