Collections Specialist I - HMO/PPO (REMOTE)

Essential Duties and Responsibilities:

• 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

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.

PREFERRED

• Artiva
• HMS

 EDUCATION AND EXPERIENCE

• Required High School Graduate or GED equivalent
• 1 Year Medical collections experience
• Minimum 1 year experience in a hospital business office department.