Medical A/R Collections Specialist

Summary Responsible for all aspects of Medical A/R collections, claim status and denial management.

Essential Duties and Responsibilities include the following. Other duties may be assigned as needed to meet our department productivity standards.

• Completes follow up on outstanding medical A/R insurance claims with no response directly with payers
• Works various denials from insurances including coverage in question, medical necessity, re-bundled, incorrect coding, credentialing, etc.
• Reviews electronic rejections
• Completes incoming correspondence from patients and or insurance
• Works with coders on any coding and billing issues to correct and or appeal errors in a timely manner
• Initiates refund/credit requests.
• Properly documents the patient account of all steps taken to resolve balance pending by payer or patient
• Escalate problems with electronic claims submissions and or bulk rejections to manager for assistance and guidance for resolution.
• Bulk mails all manual claims to individual payers daily as needed
• Works daily, weekly and monthly aging reports as assigned

Education and/or Experience

• Strong, working knowledge of insurance payers to include government, commercial and managed care products.
• Ability to establish a good rapport with Clinic managers and Providers.
• Resourceful, steadfast attitude to make sure that claims are worked timely.
• Comfortable with navigating through the payer websites for claim status, appeals, etc..
• Excellent verbal and oral communication skills.
• Excellent customer service skills are expected with patients and clinic staff.

Other Qualifications

Must be able to multitask and demonstrate excellent time management

Must work well in a team environment

Ability to communicate well with patients and other team members in a tactful and courteous manner

Protect PHI and follow HIPPA regulations

Required to meet department quality and production standards

Maintaining and satisfying minimum attendance requirements is an essential function of this position including working all full-time regular hours as established

Knowledge of CPT/HCPCS and ICD-10.

2 years’ experience preferred in a medical office setting.