ESSENTIAL DUTIES:

Under the general supervision of the Accounts Receivable Supervisor, the Collection Specialist is responsible for collecting payments and applying to patients accounts which includes; patients, clients, and or referral sources.

RESPONSIBILITIES:

• Understands the rules, regulations, appeal process and timely filing regarding insurance billing coverage and collection process.
• Understands payer determination, contract fees, covered or non-covered items, diagnosis, modifiers, valid HCPC, prescriptions, authorization, eligibility, etc.
• Records each transaction worked on a daily basis onto a Work Productivity Log.
• Evaluates EOB payment to determine transaction billed is paid in full according to current fees and contract. Rectifies any underpayments with the insurances for additional payment.
• Audits charts to verify documentation, such as the assignment of benefits, letters of medical necessity, authorization and other required documents.
• Performs manual or electronic processing of reimbursement claims.
• Ensures billing occurs in a prompt and timely manner as well as timely follow up.
• Works on claims, denials, suspension, appeals and aging reports to determine the appropriate follow-up action.
• Ensures that goals set for denials/correspondence and aged accounts are met within the set deadlines given by your supervisor.
• Maintains accurate and complete records concerning billing and collection activity including documenting the patient's chart and system notes.
• Updates all patient information as necessary, request supporting documentation, copy of insurance card and other required information.
• Handles customer and insurance questions concerning account activity.
• Supplies supervisor or manager with current account status for collection evaluation.
• Shares with other team member's relative billing, adjustment or collection information.
• Communicates problems and concerns with supervisor/ manager which may lead to inaccurate or untimely completion of reimbursement processing.
• Work on and follow up on other projects, as assigned.
• Performs other duties, as assigned.

WORK EXPERIENCE REQUIREMENTS:

• Graduate from an accredited high school
• Two year experience in collections
• Knowledge of medical insurance payers, billing rules and regulations.
• Experience in healthcare, medical and/or HME industry (preferred).
• Computer literate and knowledge of USS program is a plus.
• Make best use of work time to complete projects and assignments as scheduled.
• Be able to work on multiple tasks. Plan and prioritize activities to achieve results and meet deadlines.
• Strong communication, problem solving and analytical skills
• Ability to work independently and adapt to a fast changing environment.
• Proficiency in Microsoft Office including Excel and Word.
• Strong organizational skills and detail oriented.
• Excellent interpersonal and customer relationship skills with the ability to work in a very fast paced environment.