Collections Specialist

Summary

The Collections Specialist is responsible for ensuring accurate billing, timely submission of electronic and / or paper claims, monitoring claim status, researching rejections and denials, documenting related account activities, posting adjustments and collections of Medicare, Medicaid, Medicaid Managed Care, and commercial insurance payers. The Collections Specialist must possess critical thinking skills and understanding of Medicare, Medicaid eligibility requirements as well as commercial insurance payer payment methods to correctly record contractual adjustments base on payer contracts or government regulations. In addition, the Collections Specialist must demonstrate proficiency with billing system to ensure all functionality is utilized for the utmost efficient processing of claims.

Essential Functions

• Have understanding and working knowledge of the EPIC PB / HB revenue cycle system.
• Work accounts from an Epic work queue on a daily basis.
• Responsible for resolution and collection of outstanding insurance claims thru the completion of the adjudication process.
• Must have Medicare / Medicaid working knowledge and billing experience.
• Must have relative and current experience working with commercial and other non -government payers thru the billing and denials process.
• Understanding and knowledge of reading and interpretation of a RA (remittance advice) and EOB (explanation of benefits).
• Experience and knowledge of researching payments and denials on multiple payer websites.
• Must be experience in calling any and all payers if the online portals information is incomplete or additional clarification is required for an outcome.
• Able to download medical records or other documentation on the portal upon request, for payment of insurance claims (including colored photos).
• Understanding and skill set in submitting written appeals to insurance companies disputing denials.
• Adjudicate the EOB and RA if additional adjustments are necessary and were not applied on the original posting of the EOB / RA.
• Process patient and insurance refunds as necessary and efficiently.
• Communicate effectively with supervision, accurately and efficiently, while handling high claim volume

Required Education and Experience

High School Diploma or equivalent required.

Customer service experience and basic computer skills required, preferably in a Windows environment with electronic medical records software.

Preferred Education and Experience

2 or more years Epic System experience working in revenue cycle

Medicare and Medicaid claims processing knowledge

Medical terminology or other previous medical office experience desirable

Knowledge of Ophthalmic terminology

Pre-certification experience

Continuing education

Competencies

Work Environment

This is a clerical job in a healthcare clinical setting. The Collections Specialist will primarily work in an office setting but may be required to walk to other areas of the clinic and may be exposed to contagious illnesses due to patient interactions.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. This position is occasionally active and requires standing and walking for the duration of the shift. In addition to the aforementioned demands, this position requires sitting for extended periods of time.

Position Type and Expected Hours of Work

This is a full-time position working primarily daytime hours Monday through Friday; however, some evening and weekend work may be necessary on occasion.

Other Duties

Please note that this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.