Medical Collection Specialist

JOB TITLE:       Medical Collection Specialist    

REPORTS TO:  Revenue Cycle Manager 

FLSA STATUS: Non-Exempt                                                         

JOB SUMMARY: 

In-depth knowledge of Procedural Coding, Specialist in identifying appropriate ICD10 coding based on CMS/HCC categories, CPT, HCPCS CMS 1500 FORM, Super Bill, Electronic Claims Submission and Clearing House Operations, EOB, Payments, Denials, and appeals. 

QUALIFICATIONS/EDUCATION:

• High School Diploma required. 
• Minimum 1 years of experience in billing and/or medical collections 
• ECW experience preferred.
• Pathology Billing experience
• Bilingual English/Spanish Preferred; must be able to read, write and speak English. 
• Computer Knowledge: MS word, MS Excel internet, document with Electronic Health Records and/or authorization system with minimal typing/spelling errors, send emails and faxes. 

CERTIFICATIONS/LICENSES:

• CPC Certified Preferred

 ABILITIES/SKILLS:

• In depth knowledge of ICD10 and HCPCS coding.
• Excellent communication, Customer Service and telephone skills.
• Strong organizational skills and ability to multi-task effectively. 
• Must be able to work independently with minimal supervision.
• Able to respect and maintain patient confidentiality at all times. Functions with minimal direct supervision.
• Must be dependable and conduct him/herself in a professional manner.
• Demonstrates skill in use of personal computers, various programs and applications required to competently execute job duties.
• Must be able to follow policies and procedures.

ESSENTIAL DUTIES/ RESPONSIBILITIES: 

• Identify denial trends and make recommendations for resolutions.  
• Process rejections/denials and resubmit claims as needed.
• Appeal denied claims and follow up as needed.
• Answer patients’ or insurers’ billing questions and resolve issues or disputes in a timely manner.
• Review patient information to determine or identify claim denial causes.  
• Communicate with insurance companies for claim(s) payment.
• Request correct adjustment to resolve outstanding account balances.
• Maintain accurate and detailed chart notes in the system.
• Follow- up on patient denials prior to the payer’s appeal deadline.
• Perform any other duties as assigned.

PRE-EMPLOYMENT REQUIREMENTS

• Criminal Background Check

We offer a competitive salary; Employee Health Insurance is covered at 100%. We also offer Dental, Vision, Life, and 401k Benefits.