Collections Specialist

Job Description:

We are seeking a dedicated Medical Collections Specialist for our Revenue Cycle Team. In this position you will be responsible for the collections of insurance claims.

Responsibilities

• Understand Third Party Billing and Collection Guidelines.

• Identify root cause of issues and demonstrate the ability to recommend corrective action steps to eliminate future occurrences of denials.

• Meet quality assurance, benchmark standards and maintain productivity levels as defined by management.

• Contacts payer, or patient as appropriate

• Documents all collections activity in patient collections notes

• Documents work performed/action taken on AR Aging Report and/or Over/Under Report

• Process all Payer appeal requests within the time frame required by the Payer

• Processes all approved adjustments

• Processes rejections and denials to determine if the claim needs to be refiled or submitted for an appeal with the payer

• Reviews patient information in appropriate system to determine why the claim is unpaid, if an adjustment is valid and whether additional approval is required

• Able to identify errors, correct claims and reprocess for reimbursement

• Able to read and interpret an EOB for accurate understanding of denial

• Knows how to investigate claims, contracts for reimbursement

• Performs other duties as assigned

Qualifications

Employment is contingent on

• Background investigation (company-wide)

• Drug screen (when applicable for the position)

• Valid driver's license in state of residence with a clean driving record (when applicable for the position)

Education & Experience

• High school graduate or equivalent. Excellent interpersonal, organizational, communication and effective problem-solving skills are necessary.

• High school diploma or GED equivalent

• One to three years of related prior work experience in a team-oriented environment

• Experience in medical field and administrative record management

• Strong customer service background

Skills & Abilities

• Ability to communicate with patients, payors, outside agencies, and public through telephone, electronic and written correspondence.

• Effectively communicate in English; both oral and written, with physicians, location employees and patients to ensure questions and concerns are processed in a timely manner

• Helpful, knowledgeable, and polite while maintaining a positive attitude

• Interpret a variety of instructions in a variety of communication mediums

• Knowledge of Home Infusion

• Knowledge of insurance policies and requirements

• Knowledge of medical billing practices and of billing reimbursement

• Maintain confidentiality and practice discretion and caution when handling sensitive information

• Multi-task along with attention to detail

• Must be able to accurately perform simple mathematical calculations using addition, subtraction, multiplication, and division

• Self-motivation, organized, time-management and deductive problem-solving skills

• Work independently and as part of a team

• Collections or medical billing experience with basic understanding of ICD9, CPT4, HCPCS, and medical terminology is preferred.

• Familiarity with third party payor guidelines and reimbursement practices and available financial resources for payment of balances due is beneficial.

• Medicare knowledge of billing requirements specific to DMEMAC

• HCN360 and CPR+ knowledge preferred.

CarepathRx offers a comprehensive benefit package for full-time employees that includes medical/dental/vision, flexible spending, company-paid life insurance and short-term disability as well as voluntary benefits, 401(k), Paid Time Off and paid holidays. Medical, dental and vision coverage are effective 1st of the month following date of hire.