Position Title: Medical Collections Representative

Department: Billing & Collections

Billing Specialists will be responsible for accurately coding and submitting medical claims and reconciling rejections/denials from insurance payors. Specialists must have a thorough understanding of medical billing procedures, coding guidelines, and insurance regulations, along with strong analytical and communication skills.

Responsibilities:

1. Claims Preparation and Submission: Prepare and submit medical claims to insurance companies and government payers using appropriate coding and billing procedures. Ensure accuracy and completeness of claim forms, including patient demographics, diagnosis codes, CPT/HCPCS procedure codes, and modifiers.

2. Coding Review: Review medical documentation and patient records to assign accurate diagnostic and procedural codes in compliance with coding guidelines and regulations (e.g., ICD-10-CM, CPT, HCPCS). Identify any discrepancies or missing information that may impact claim processing or reimbursement.

3. Claims Processing: Submit claims to insurance companies, government and independent payers accurately and in a timely manner.

4. Payment Posting and Reconciliation: Post payments received from insurance companies, patients, and other third-party payers to patient accounts accurately and in a timely manner. Reconcile payments with billing records, resolve discrepancies, and identify outstanding balances for follow-up.

5. Denials Management: Investigate initial claim denials and rejections from insurance companies. Identify root causes of denials, such as coding errors or lack of documentation, and take corrective actions to resubmit claims and maximize reimbursement.

6. Contract Compliance: Monitor payer adherence to contractual obligations and escalate issues as needed. Provide insights and recommendations to optimize contract performance and reimbursement rates.

7. Compliance and Documentation: Ensure compliance with healthcare regulations, including HIPAA, Medicare, and Medicaid guidelines, in handling patient information and billing records. Maintain accurate and detailed documentation of billing activities, claim submissions, and communications with payers and internal stakeholders. Protects company value by keeping collection information confidential.

To learn more, please visit us at: www.ethosoutcomes.com

Ethos Therapy Solutions is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, gender identity, veteran status, or military status. Ethos Therapy Solutions complies with all applicable federal, state and local laws concerning non- discrimination.

Job Type: Full-time

Pay: $21.00 - $22.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Work setting:

• JCAHO accredited facility
• Office

Ability to Relocate:

• Blue Bell, PA 19422: Relocate before starting work (Required)

Work Location: In person