Collections Specialist

Description

The Collector is responsible for accurate and timely billing and collection of outstanding receivables from third party payers and payer representatives. Maintaining accurate account balances in accordance with contractual obligations, fee schedules, or regulations is required job duty.

Essential Functions:

1. Reviews third party claims for accuracy and completeness using patient accounting functionality. Submitting claims to third party payers within timely filing restrictions.
2. Performs follow up activities by telephone or electronic inquiry on accounts with outstanding third party payer balance to determine status of claims in accordance with payer specific follow-up guidelines.
3. Attempts to expedite claim adjudication by resolving issues that may delay processing, involving the patient/guarantor as necessary.
4. Clearly and concisely documents pertinent follow up activity upon completion of each occurrence in patient accounting system.
5. Resubmits claims to payers as necessary - submitting secondary or tertiary plan claims as required.
6. Ensures accurate account balances for proper account processing and reporting, requesting contractual allowances, adjustments , and balance transfers as necessary.
7. Communicates with other revenue cycle staff members, Utilization Review/Case Management, and site leadership to ensure timely and accurate claims payments.
8. Researches and resolves credit balance accounts as requested by payers or as identified on aging reports.
9. Completes daily and weekly productivity/performance reporting as directed by management.
10. Performs other duties and projects as assigned.

Requirements

Educational / Experience Requirements:

• High school diploma or equivalent as minimum requirement.
• Previous experience with interpretation of insurance plan benefits, conditions of payment, and billing requirements.
• Previous customer service experience in a similar field, including employment as a call center worker, credit authorizer or customer service representative, is also beneficial. Due to the sensitivity and confidentiality of financial records, collectors are required to be in strict accordance with the rules regarding collection attempts regulated by the Federal Trade Commission (FTC).

Qualifications/Skills:

• Experience in Microsoft Office products and general patient accounting systems.
• Knowledge of third party payers, Medicare, Medicaid, and other payer requirements.
• Effective communication abilities for phone contacts with insurance payers to resolve claim issues.
• Customer service skills for interacting with patients regarding medical claims and payments, including communicating with patients and family members of diverse ages and backgrounds.
• Able to work in a team environment.
• Ability to function with minimal supervision and complete understanding and respect of confidentiality.
• Follows policy and procedures that are in accordance with State and Federal Laws, JCAHO, HCFA and other regulatory boards as required by state and federal laws as well as the mission statement.

Work Environment:Subject to many interruptions. Occasional pressure due to multiple calls and inquiries. This position can be high paced and stressful; must be able to cope mentally and physically to atmosphere. Work requires spending approximately 90% or more of the time inside a building that offers protection from weather conditions but not necessarily from temperature changes.