JOB DESCRIPTION

Summary/Objective

Medical Collections Specialists are responsible for all functions related to the collection of payment on patient accounts. Essential to this position is the ability to manage all insurance follow-up for maximum insurance reimbursement. To include outbound and inbound insurance carrier calls, reprocessing claims, drafting appeals, working denials and resolving unpaid claims.

Essential Functions

· Follow up on outstanding claims and unpaid accounts, proactively identifying and resolving billing and collection issues.

· Resolve claim denials and discrepancies by conducting thorough research, contacting insurance companies, and appealing denials when necessary.

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

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

· Notifies Supervisor of claim edits that could be reduced/eliminated through system modifications and/or communication and feedback to the department or other areas.

· Follow established Collections processes and procedures.

· Calculates patient responsibility, interpret explanation of benefit message codes, identify payment discrepancies by contacting insurance carrier and determining if rebilling is necessary.

· Records pertinent data on collection efforts and customer financial status in database.

· Collect clinical information requested by insurance companies.

· Monitor and maintain assigned accounts, account adjustments, small balance write off, customer reconciliations and process patient and insurance refunds.

· Ensure compliance with all corporate policies and procedures, third party payer requirements, and governmental laws and regulations.

· Provide regular communication with the team and management regarding collections.

· 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.

· Communicates all payment issues on accounts to Collections Supervisor so timely communication can be made to the families.

· Ability to analyze and interpret documents, contracts, notes, and other correspondence.

· Manage multiple tasks, prioritizing workload in an efficient manner.

· Special Projects as assigned.

Performance Metrics-

· Ensure all appeals, reconsiderations, and/or corrected claims are submitted within appropriate time limits set by payors.

· All incoming mail worked within 48 hours of receipt.

· Denials or short pays identified by payment posting worked within 1 week of receipt.

· 60 – 90 day aging report for assigned payors worked each month to ensure all claims are on file no deadlines are missed

· Top 10 accounts for assigned payors worked monthly and results reported to Collections Supervisor by 2nd business day of the following month.

Preferred Education and Experience

· Associates Degree preferred

· Brightree experience is a plus.

· DME Collections Experience highly preferred.

Supervisory Responsibility

No

Work Environment

In Office or Remote

Physical Demands

Able to lift and carry up to 10lbs

Position Type/Expected Hours of Work

This is a full-time position. Days and hours of work are Monday through Friday, 8:00 a.m. to 5 p.m. or other agreed upon schedule

Travel

None

Organizational Requirements

1. Experience recognizing the needs and concerns of individuals.

2. Effectively communicate orally and in writing

3. Ability to follow verbal and written instruction.

4. Professional telephone & email etiquette

5. Able to work in a fast-paced, self-directed environment.

6. Detail oriented with excellent time management skills.

7. Decision-making, problem resolution and creative thinking skills.

8. Responds well to multitasking while providing exceptional customer service, support, and responsiveness.

9. Should be honest, competitive, energetic, enthusiastic, professional, and systematic.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Job Type: Full-time

Pay: $20.00 - $23.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Referral program
• Retirement plan
• Tuition reimbursement
• Vision insurance

Weekly day range:

• Monday to Friday
• No weekends

Work Location: In person