AR Collections

The Collection Specialist position is a key role in maximizing revenue for Total MD by utilizing the industry standard best practices.

• Collaborates with the Billing and Coding Specialist, to coordinate the analysis, research and resolution of assigned denials.
• Consistently maintains pre-defined productivity and performance measures, to maximize accurate reimbursement and accelerate cash collections.
• Thorough understanding of the Unpaid Claims Management.
• Determines and executes the best approach for denial resolution and assists with root cause analysis of denials.

Main Position Requirements:

• Reviews denials and reprocesses claims for assigned clients.
• Responds to denials and files appeals in a timely manner.
• Reviews Explanation of Benefits (EOBs) for denial reasons.
• Reviews coding and documentation of billed services, to verify support of medical necessity and detail of procedure performed.
• Identify clinical and technical denials through EOBs, letters and patient data.
• Contacts the appropriate third party to identify appeal outcome and determines the applicable course of action.
• Communicates with Supervisor, as appropriate, to clarify coding discrepancies and ensure changes are documented.
• Re-file claims not received by Carrier and performs follow-up on all reprocessed claims.
• Facilitates the Refund Process, when credit balances are identified.
• Communicates with patients, as appropriate, to provide information regarding claim status and denials.
• Documents all account activity in the eClinical Works system.
• Retrieves and responds to voice mail messages by 5pm EST of the same day.
• Identifies appropriate escalation points and works with the Supervisor to resolve issues.
• Assists with the identification of trends and root cause analysis, relative to denied claims, and communicates with the Supervisor, as appropriate, to reduce reimbursement delays and minimize denials.
• Maintains a comprehensive understanding of State and Federal Regulatory Requirements, relative to denial management, as well as resources and tools available to gather information for denial review and appeal.
• Consistently meets pre-defined productivity metrics and performance standards.
• Performs all responsibilities, in accordance with Total MD Policies and Procedures, and within the appropriate scope of practice.
• Ensures compliance with HIPAA Privacy and Security Policies and Procedures.
• Attends required meetings, in-services and training sessions.

Management Responsibilities: None

Additional Responsibilities & Skills:

• Demonstrates effective, professional verbal and non-verbal communication skills.
• Demonstrates attention to detail and the ability to apply payer contract language to billing.
• Demonstrates the ability to be flexible and work collaboratively with multiple internal and external departments.
• Demonstrates the ability to effectively investigate, analyze and problem solve.
• Demonstrates proficiency working with eClinical Works and Microsoft Office, including Excel and Word.

Knowledge and Experience:

High School diploma or GED required.
Minimum five (5) years previous experience in Healthcare Billing or Patient Financial Services.
Minimum five (5) years recent experience with Commercial Third Party Insurance requirements;
Experience with eClinical Works systems preferred.

Comprehensive knowledge and demonstrated competency in the following areas:

CPT /ICD-10 Codes and Medical Billing Terminology
Payer Documentation Standards
Personal Injury, Medicare, and Commercial Reimbursement Requirements

Job Type: Full-time

Pay: $18.60 - $19.40 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Work setting:

• Office

Experience:

• ICD coding: 1 year (Preferred)
• CPT coding: 1 year (Preferred)

Work Location: In person

Salary : $19 - $19