Collections Specialist

Position Summary:

The Collections Specialist is responsible for timely and accurate claims filing, review, and resolution of denied insurance claims. The Collections Specialist will review all billing information such as provider medical records, billed claims, insurance carrier explanation of benefits, insurance carrier denial letters, and electronic remits to ensure that payments and denials are worked promptly and appeals for the denied claims are submitted appropriately.

Essential Duties and Responsibilities:

• Daily monitoring of open claims receivable’s volume, appeal filing deadlines (reconsiderations, appeals, negotiations, IDR and TDI), open collection efforts to ensure all identified and standardized workflows and processes are followed.
• Review, file and follow up on payer denials, rejected claims, and appeals in a timely fashion.
• Research and resolve incorrectly paid claims. Identify any denial trends and escalate to Associate Director for review.
• Daily tracking of incoming emails and correspondence for open collection activities to ensure timely response and scheduling of negotiation, mediations, and arbitrations.
• Daily monitoring of internal tracking documents to verify timeliness and efficiency of collection work and follow up.
• Review, preparation and management of weekly administrative invoicing to ensure all accounts are properly accounted for and payments are processed timely.
• Conduct daily, weekly, monthly audits of workflow and processes to ensure all identified and assigned collection tasks are implemented and maintained. Identify any areas of training and education and report to Associate Director.
• Schedule, prepare and conduct mediations. Track and report any trend or areas for process or workflow improvement.
• Conduct education and training as necessary.
• Ensure compliance with all healthcare state and federal regulations, privacy laws and billing requirements.
• Perform other duties as assigned.

Education and Experience:

• Extensive experience in collections, denials management, NSA, IDR, TDI and negotiations; preferable in a free-standing emergency room facility setting.
• In-depth knowledge of healthcare regulations, privacy laws, and billing requirements.
• Strong billing and coding background, preferred in free standing emergency room setting.
• Excellent communication and interpersonal skills.
• Ability to analyze data, identify trends, and make data-driven decisions.
• Proficient in using healthcare information systems and patient access software.
• Experience in process improvement and implementing best practices.

Physical Demands:

The physical demands for this position include: adequate vision, hearing, and repetitive motion. Light physical activity performing non-strenuous daily activities of an administrative nature. Ascending or descending stairs, ramps, and the like, using feet and legs and/or hands and arms. Substantial movements (motions) of the wrist, hands and/or fingers in a repetitive manner. Bending legs downward and forward by bending leg and spine.

Work Environment:

Well-lighted, heated and/or air-conditioned indoor office setting with adequate ventilation.