Medical collections specialist job description

· Do you know the CMS 1500 form by heart?

· Have you previously been in a Medical Reimbursement position?

If you said "yes" to all of these questions, you may be the next team member we're looking for!

POSITION SUMMARY

The Medical Collections Specialist is responsible for evaluating medical insurance cases that are denied coverage and researching whether the case merits an appeal. They support the billing department in meeting expectations regarding efficiency, privacy maintenance and quality of decision making. They initiate follow-up phone calls on accounts following departmental policy and procedure and best-practices. It is expected that they project a professional company image through in-person and phone interactions.

PRINCIPLE ACCOUNTABILITIES

Review patient accounts to determine whether all relevant information has been submitted

Identify and report payer denial, payment; recoupment trends and/or out of network errors with carriers to designated associate

Manage the flow and subsequently evaluate, research and process all appeals, grievances and provider review requests according to payer specific guidelines

Conduct appropriate investigation of all appeals

Interacts with payers to resolve outstanding / denied claims issues, sends statements and makes collection calls

Prepare appropriate written documentation and maintain necessary files

Initiate follow up phone calls on all necessary accounts

Follow up on all written and telephone correspondence

Document appropriate follow up notes on accounts and upkeep of any daily spreadsheets required by supervisor

Notify leadership of, and respond to, additional documentation requests (ADR), audits, and/or post payment review

Scan all documents relating to the patient/claim into EHR

Show work to maintain accountability and identify trends

Additional duties as assigned

JOB REQUIREMENTS

EDUCATION: High School Diploma or equivalent. Bachelor’s degree preferred
EXPERIENCE: 3 years accounts receivable experience in the medical field required. Experience with medical terminology and insurance industry and out-of-network.
SKILLS: Ability to prioritize and handle multiple tasks in a changing work environment. Excellent written and verbal communication skills. Ability to work independently and on a team. Ability to interpret an Explanation of Benefits and take additional and necessary steps towards payment. Familiarity with Microsoft applications and database software. Strong attention to detail. Must be proficient with CPT, ICD-10 and HCPCS coding.

WORKING CONDITIONS
Working conditions are normal for an office environment.

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Provides medical collection services for TLRA collection units. Utilizes a strong background as a medical collection specialist to successfully resolve accounts placed with TLRA for collection. This involves performing collection activities related to follow-up and account resolution, and includes communication to patients, clients, reimbursement vendors, and other external entities while adhering to all client, state and federal guidelines. Patient and client satisfaction is essential. Associates in the collection unites are expected to knave knowledge of the overall collection work processes for the both active AR and BD inventory.

* Provides effective collection services, ensuring the successful recovery of accounts in accordance with client and state guidelines as well as TLRA's business objectives

* Documents and updates patient account information in TLRA's collection software system timely and accurately to include appropriate account status.

* Handles inbound patient and/or carrier calls promptly and professionally, providing assistance and resolution to account inquiries, issues and request.

* Uses collection tools effectively to ensure quality recovery services and meet or exceed established goals and work standards.

* Performs research and analysis of account issues and strives to resolve problems timely and accurately.
* Ensure daily productivity standards are met.
* Promotes positive patient relations by communicating in a manner that demonstrates respect for the human dignity of patients and/or their families.
* Performs other special projects as required when assigned.

Requirements:

* Must have minimum of 3 years' experience in a Customer Service call enter environment with a focus on healthcare billing/collections or collection agency environment or 3 years' experience working in a client service or marketing capacity, preferably in a healthcare or collection agency environment.
* General hospital A/R accounts knowledge is required.
* PC skills in a Windows environment are required. Solid knowledge and utilization of desktop applications to include Word and Excel are essential.
* College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.

Work Type:

Full Time

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AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare Foundation!

Does the idea of doing something that really makes a difference in people's lives while being well-compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its employees?

If so, AIDS Healthcare Foundation is the place for you!

Founded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our mission is to provide cutting edge medicine and advocacy, regardless of ability to pay. Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them.

AHF's core values are:

• Patient-Centered

• Value Employees

• Respect for Diversity

• Nimble

• Fight for What's Right

STILL INTERESTED? Please continue!

The Medical Collections Specialist-East Region contributes to AHF's mission by projecting and integrating within and outside of Department of Medicine. Within their duties of claims submission, claim edits, payment posting and cashiering, credit and refund processing, insurance follow up, denial management, patient follow-up, and patient collections.

By verifying patient insurance eligibility and ensuring scope of coverage this position has the opportunity to give stand out service that enhances the reputation of AHF and encourage patients to return to an AHF center and recommend it to others. In addition, by following up professionally to any billing related telephone calls and answer questions from patients, staff, and other interested parties within 24 hours of receipt, demonstrates the core values of AHF.

Precision in the handling of refunds, overpayments on accounts and transfers payments to the appropriate account/accounts under management approval, maximizes the revenue to AHF.

The medical biller adds consistent value to the revenue cycle /DOM department by adapting to various situations with ease and by being flexible.

We at AIDS Healthcare Foundation believe that each individual is entitled to equal employment opportunities without regard to race, color, creed, gender, sexual orientation, gender identity, marital status, national origin, age, veteran status or disability. The right of equal employment opportunity extends to recruiting, hiring selection, transfer, promotion, training and all other conditions of employment.

Req No: 2022-15846

External Company URL: www.aidshealth.org

Street: 700 SE 3rd Ave.