Medical Collections Specialist

Role Overview

• The primary responsibility of the Medical Collection Specialist is to ensure effective collection of all patient accounts.
• Perform extensive insurance claim follow-ups for insurance denials, appeals, and perform next steps a must.
• Ability to utilize multiple patients accounting and billing applications including but not limited to claims clearing house systems, payer websites.
• Ability to interact with the payer representatives, HIM, Insurance Verification and Access Service departments.
• Participates in group meetings and /or various committees.
• Ability to effectively present information regarding denial trends, and present to management.
• Ability to read, understand, interpret and resolve payer denials and EOB's.
• Ensure denial reviews, claim follow-ups are conducted in a timely manner in accordance with payer timely filing limits.
• Correct claims and file appeals with supporting documents to insurance companies, by phone, electronically or mail.
• Ability to work receivables to investigate and resolve denials and partial payments.
• Ability to calculate reimbursement per payer contract.

Requirements

• High School Diploma
• 3 to 5 years previous experience in office billing and collections
• High degree of attention to detail and accuracy
• Ability to prioritize work assigned independently and multi-task
• Knowledge of insurance, billing terms, CPT/ICD10, coding and DRG
• Knowledge of modifiers usage and CCI edits
• Strong medical insurance background
• Working knowledge of MS Office applications
• Critical thinking skills
• Spine/Orthopedic surgery experience preferred
• EPIC experience preferred
• Minimum of three years’ experience in medical collections.
• Hospital Billing/Collections preferred

Benefits

• Hybrid working arrangement