Collections Specialist - Healthcare is responsible for requesting payment and collecting overdue balances from patients. Contacts patients by phone or mail to request payment and to review their account details. Being a Collections Specialist - Healthcare responds to patient questions and sets up alternative pay plans if necessary. Maintains patient account records and resolves third party payer issues. Additionally, Collections Specialist - Healthcare typically requires a high school diploma. Typically reports to a supervisor or manager. The Collections Specialist - Healthcare works under moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. To be a Collections Specialist - Healthcare typically requires 1-3 years of related experience. (Copyright 2024 Salary.com)
Wage range: $25 - $34 per hourStatus: Non-ExemptLocation: RemoteSchedule: Monday - Friday
What does the HMO
Billing and Collections Specialist do?
In this role you will be responsible for recording all
revenue, electronic claim submissions, and timely collection from all HMO payer
sources. If you have a keen eye for detail, ensure timely follow up, and love
to check things off, this role is for you!
In This Job, Every Day
You Will:
Monitors HMO claims by reviewing and clearing
HMO dashboard daily, verifying eligibly, reviewing case management software,
and ensuring payer and claim form is set up in patient records.
Ensures all billing and collections are pursued
in a timely and effective manner for assigned centers, including researching,
adjustments and rebills as needed.
Identifies reconsiderations, appeal
opportunities, and collaborates and coordinates with facility staff to fulfill
audit requests.
Completes HMO Triple Check with assigned centers
to ensure UB-04 claim forms are correct and all revenue is accounted for and
booked correctly. Ensures HMO billing is submitted by the 5th day and verifies receipt of claims by the 7th business
day.Follows Prestige collections policy for all HMO
payers and reports in a timely manner. Documents all collection efforts in the
patient billing record and healthcare software.
Reviews business intelligence software data and
revenue cards and posts all revenue in companys healthcare software.
Ensures revenue is properly booked and billed by
utilizing exclusion worksheets.
Research denials and over/under payments for all
HMO claims. Submits and processes all revenue adjustments and saves
documentation according to company policy.
Maintains in-depth knowledge of all HMO
contracts and contract changes. Provides education and communication to team
members regarding HMO contracts.
Maintains constant communication with the
centers Administrator, Business Office Manager (BOM), Admission Director, and
Regional Manager of Field Accounting (RMFA).
Performs other duties as assigned.
Education & Experience
You Need to Qualify:
Associates degree in business, accounting or
finance or equivalent knowledge and skills obtained through a combination of
education, training, and experience.
Minimum of 2 years experience in a healthcare
or accounting environment with an emphasis on HMO contracts, billing, and
collections.
Knowledge of HMO contracts and Medicare/Medicaid
regulations preferred.
Ability to creatively problem-solve, be a team
player, be well organized and flexible.
Experience in the development and training in
accounting procedures and rules, and multi-site coverage an asset.
Must be proficient with Microsoft Excel,
accounting software, and experience with EHR and billing systems/software.
Ways you can advance
beyond the Senior Maintenance role:
Once you master this role, you could consider the Regional
Manager of Field Accounting or the Director of Field Accounting positions.
EOE/M/F/VETS/DISABLED At Prestige, it is our promise to
personally touch lives every day. It is a philosophy of caring based on our
core values of integrity, trust, commitment, and respect, that are at the
center of all that we do. We are committed to a diverse and inclusive workforce
that represents all of us, coming from different experiences, cultures,
backgrounds, and viewpoints. Inclusion is the way we treat one another and how
we celebrate what makes us different.
Prestige is proud to be an Equal
Employment Opportunity employer. We do not discriminate based upon race,
religion, color, national origin, gender (including pregnancy, childbirth, or
related medical conditions), sexual orientation, gender identity, gender expression,
age, status as a protected veteran, status as an individual with a disability,
or other applicable legally protected characteristics. Who is Prestige Care/Prestige Senior Living?Prestige Care is a family of over 75 skilled nursing post-acute care centers, as well as assisted living and memory care communities in 8 Western states. We are an organization of over 5,000 team members who serve thousands of residents, where we have the privilege of personally touching their lives every day.We have four core values of integrity, trust, commitment, and respect that guide everything that we do. With a strong commitment to career development and advancement, Prestige Care is a employer that can help you achieve your career goals and objectives. With a healthcare career at Prestige Care, you will enjoy a collaborative, team-oriented environment where your work truly matters at the end of every day.Summary of BenefitsFull-time team members are eligible for
Prestiges comprehensive benefit package including choice of medical plans,
HSA/FSA accounts, dental and vision insurance, and company paid life and
AD&D insurance. All team members are eligible to participate in the
companys retirement plans with a company match for those who meet the hours
and service requirements. Additional benefits include Employee Assistance
Program and Education Reimbursement program. PTO:SNF/AL/PCI Salary: Accrue PTO at rate of 0.0615/hour during their first year/16 days. SNF/PCI Hourly: Full-time and Part-Time team members (over
20 hours/week) accrue PTO at rate of 0.0423/hour during their first year.