Medical A/R Collections Specialist

Responsible for all aspects of Medical A/R collections, claim status and denial management.

• Completes follow-up on outstanding medical A/R insurance claims with no response directly with payers
• Works various denials from insurances including coverage in question, medical necessity, re-bundled, incorrect coding, credentialing, etc.
• Reviews electronic rejections
• Completes incoming correspondence from patients and/or insurance
• Works with coders on any coding and billing issues to correct and/or appeal errors timely
• Initiates refund/credit requests
• Properly documents the patient account of all steps taken to resolve balance pending by payer or patient
• Escalates problems with electronic claims submissions and/or bulk rejections to manager for assistance and guidance
• Bulk mails all manual claims to individual payers daily as needed
• Works daily, weekly and monthly aging reports as assigned

Requirements:

Strong working knowledge of insurance payers including government, commercial, and managed care products. Ability to establish a good rapport with clinic managers and providers. Resourceful and steadfast attitude to ensure claims are worked timely. Comfortable navigating payer websites for claim status, appeals, etc. Excellent verbal and oral communication skills. Excellent customer service skills with patients and clinic staff. Must be able to multitask and demonstrate excellent time management. Works well in a team environment. Ability to communicate tactfully and courteously with patients and team members. Protect PHI and follow HIPAA regulations. Required to meet department quality and production standards. Maintain minimum attendance requirements including working all full-time hours as established. Knowledge of CPT/HCPCS and ICD-10. Preferred 2 years experience in a medical office setting.