Insurance Billing-Collector

United Surgical Partners International Inc (USPI)

Insurance Billing-Collector

San Antonio, TX
Full Time
Paid
  • Responsibilities

    ESSENTIALS DUTIES AND RESPONSIBILITIES:

    · Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers including self-pay to obtain maximum reimbursement.

    · Manage daily work queue to prioritize high dollar claim balances.

    · Review & work incoming insurance and patient correspondence including refund requests.

    · Send appeals when appropriate or provide the requested medical documentation.

    · Ability to review medical documentation to justify medical necessity.

    · Take incoming patient phone calls to resolve inquiries, billing issues, or outstanding balances.

    · Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents.

    · Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD’s) for claim resolution.

    · Negotiate payment amounts for procedures with Third Party Administrators for out of network providers.

    · Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.

    Required Skills:

    · 2+ years of revenue cycle

    • Ability to read and interpret insurance explanations of benefits and managed care contracts.
    • Must communicate effectively, both verbally and in writing, with internal and external clients.
    • Must be able to multi-task and handle competing priorities while meeting or exceeding deadlines.
    • Knowledge or experience working with a variety of health care insurance payers is preferred.
    • High School Diploma or equivalent.

    Required Skills

    Required Experience

    General knowledge of the healthcare industry insurance/EOB payment process