Collections Representative - Remote

OTitle: Collections Representative (3034984)

Location: Weatherford, TX 76086 / Remote - Must reside in TX

Type: 06 Months Contract (26 Weeks)

Shift time: Day; 5x8-Hour (08:00 - 17:00)

Description:

Remote: Must reside in TX

REQUIRED candidate qualities:

2 years epic experience

At least five years of hospital or facility medical billing/ insurance collections experience.

Experience with insurance collections

Not a patient collections role: Focus is on insurance medical billing collections, not collecting copays/outstanding patient balances. Responsibilities include calling insurances, submitting appeals, finding authorizations, etc.

Experience required with:

Medicare, Medicaid, managed Medicare payers (e.g., Humana, UnitedHealth, WellPoint)

Preparing appeals, handling authorizations

Denial code understanding

Epic experience mandatory.

MINIMUM QUALIFICATIONS

EDUCATION/EXPERIENCE

High School Diploma, Bachelors preferred. Minimum 5 years hospital billing experience.

The Hospital Technical Denials Claims Collector is responsible for analyzing payer underpayments, variances, and claim denials. This role requires identifying trends, escalating issues, and providing well-documented appeals in alignment with contractual agreements and policies. The collector ensures timely processing of assigned accounts by adhering to established production guidelines and workflow requirements.

Key Responsibilities and Expectations:

· Investigate and resolve denied claims by reviewing payer policies, agreements, and reimbursement structures.

· Conduct outbound calls and utilize payer websites to validate claim receipt and adjudication status within required timeframes.

· Maintain detailed and accurate documentation of all account activities, including calls, correspondence, and appeal outcomes.

· Collaborate with internal departments, including physician billing teams and client-based research teams, to ensure proper claim invoicing and resolution.

· Stay informed on payer policies and reimbursement models for all payer types, participating in special projects and strategic initiatives as needed.

· Apply appropriate adjustments based on plan reimbursement requirements.

· Prepare and submit appeals to insurance companies to overturn denials, providing necessary documentation and justification.

· Correct errors and resubmit claims to insurance companies after resolving denial issues.

· Contribute to the overall efficiency of the revenue cycle by identifying and addressing issues that lead to denials and underpayments.

· Adapt to changing priorities and work demands while maintaining a high level of quality and efficiency.

· Demonstrate a strong commitment to productivity by staying focused and on task without constant supervision.

SKILLS and Qualifications:

· Work both independently and collaboratively within a team to achieve production goals and deadlines.

· Familiarity with medical billing procedures, coding systems (e.g., ICD-10, CPT), and payer guidelines.

· Knowledge of various insurance plans, their policies, and claim processing requirements.

· Effectively communicate with colleagues and Supervisor to ensure clarity, alignment, and successful outcomes.

· Take ownership of assigned tasks and projects, demonstrating accountability and reliability in meeting expectations.

· Prior experience in working with hospital claim denials and appeals is required.

· Ability to appeal denied claims and overturn the denial when it is determined that payment is due.

· Experience working with 835 files in addition to paper and/or electronic EOB's.

· Knowledge and experience with handling and resolving NCCI edits, LCD/NCD issues, and bundling denials.

· Attention to detail

· Ability to read and understand all communication received from an insurance carrier. This will include EOB's, denial letters, audit letters, and other request letters.

· Knowledge and experience using payer portals (i.e. Availity, Evicore, etc.)

· Experience with reviewing medical records and itemized bills.

· Experience using electronic medical record (EMR) systems and billing software such as Epic.

· Strong investigative and problem resolution skills.

· Microsoft Office software experience

· Ability to read and interpret medical procedures and terminology

Job Type: Contract

Pay: $22.59 - $25.00 per hour

Application Question(s):

• If interested, please leave your email, contact number and best time to reach you
• Are you vaccinated for covid-19?

Education:

• Bachelor's (Preferred)

Experience:

• Epic: 3 years (Preferred)
• hospital or facility medical billing/ insurance collection: 5 years (Preferred)

Work Location: Remote

Salary : $23 - $25