Collection Representative

Primary Responsibilities:

• Review outstanding insurance balances to identify and resolve issues preventing finalization of claim payment, including coordinating with payers, patients and clients when appropriate
• Analyze and trend data, recommending solutions to improve first pass denial rates and reduce age of overall AR
• Accounts Receivable Specialist that has an "understanding" of the whole accounting cycle / claim life cycle
• Ensure all workflow items are completed within the set turn-around-time within quality expectations
• Be able to analyze EOBs and denials at a claim level in addition they should find trends impacting dollar and #'s, leading to process improvements
• Perform other duties as assigned
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• Graduate
• 1.5+ years and above experience in healthcare accounts receivable required (Denial Management)
• Functional knowledge of HIPAA rules and regulations and experience related to privacy laws, access and release of information
• Solid knowledge of medical insurance (HMO, PPO, Medicare, Medicaid, Private Payers)
• In-depth working knowledge of the various applications associated with the workflows
• Proficient in MS Office software; particularly Excel and Outlook
• Proven ability to communicate effectively with all internal and external clients
• Proven ability to use good judgment and critical thinking skills; ability to identify and resolve problems
• Proven efficient and accurate keyboard/typing skills
• Proven solid work ethic and a high level of professionalism with a commitment to client/patient satisfaction