Job Description

Job Summary 

The Collections Specialist I - Commercial is responsible for thorough collection and follow-up activity on insurance accounts, in order to expedite claim processing and reimbursement. Must be able to analyze patient accounts to secure and provide information to help resolve any discrepancies regarding accounts with contact to the insurance companies, government agencies, patients and other responsible parties.

Essential Functions

Ensure accurate and complete account follow-up. Resolve claim processing issues in a timely manner, evaluating problem claims to the appropriate managerial personnel with the insurance carrier’s organization to quickly resolve delinquent claims or contacting patient or third party payers in compliance with established policies and procedures. Review assigned claims working within the established productivity standards, for timely follow-up maintaining and updating all patient accounts to reflect current information. Assess each account for balance accuracy, payer plan and financial class accuracy, billing accuracy, denials, insurance requests, making any necessary adjustments, documenting appropriately and submits corrections or request for processing in a timely manner. Resolve claim processing issues on a timely basis by reviewing claim inventories, payments and adjustments and taking appropriate actions to ensure proper discounts and allowances have been completes as well as identifies account for secondary billing and processes of refers to appropriate personnel. Document all activity taken on an account in the patient account notes. Work any assigned correspondence related to assigned accounts. Perform other required duties in a timely, professional, and accurate manner.

Qualifications

H.S. Diploma or GED required 0-2 years of experience in medical collections, accounts receivable, billing, or healthcare revenue cycle operations required 1 year medical collections experience preferred 1 year of experience in a hospital business office department preferred Artiva and HMS experience preferred

Knowledge, Skills and Abilities

Ability to communicate effectively and professionally with strong attention to details and problem solving both verbally and written. Strong telephone communications skills are required. Knowledge of carrier-specific reimbursement as applicable to claim processing to include: benefits and coverage according to specific carrier, UB 04 claims form preparation 1500 claims form preparation Ability to prioritize work and meet deadlines is required. Knowledge of general office procedures is required. Ability to operate common computer systems, utilize hospital collection system and business software is required. Intermediate knowledge of Microsoft Office Tools (Outlook, Excel, Word and PowerPoint) Proficiency in hospital patient accounting and billing systems.