Overview
This role involves managing the timely collection of outstanding government or commercial healthcare insurance receivables. The specialist will work closely with healthcare organizations to improve revenue cycle processes, ensuring quality clinical care, positive patient experiences, and optimal financial results.
Responsibilities
- Verify and obtain eligibility and/or authorization using payer websites, client eligibility systems, or direct communication with insurance carriers/providers
- Update patient demographics and insurance information in relevant systems
- Research and monitor unpaid or denied claims
- Check claims for missing information, authorizations, and control numbers (ICN/DCN)
- Analyze Explanation of Benefits (EOBs) for payments or adjustments to resolve claims
- Contact payers via phone or written correspondence to secure payment, submit reconsiderations, and appeals
- Access client systems for payment, patient, claim, and data information
- Follow prioritization guidelines, timely filing deadlines, and notation protocols within appropriate systems
- Obtain necessary medical documentation requested by third-party insurance carriers
- Maintain confidentiality of patient information in accordance with insurance collection guidelines and corporate policies
- Perform other related duties as required
Requirements
- 2-3 years of experience in medical collections, denials, and appeals
- Experience handling denials including DRG downgrades, level of care, coding, and medical necessity
- Intermediate knowledge of ICD-10, CPT, HCPCS, and NCCI coding systems
- Intermediate knowledge of third-party billing guidelines
- Intermediate knowledge of billing claim forms (UB04/1500)
- Intermediate knowledge of commercial and government payor contracts
- Intermediate working knowledge of Microsoft Word and Excel
- Intermediate knowledge of health information systems such as EMR, claim scrubbers, and patient accounting systems
Preferred Qualifications
- Intermediate knowledge of one or more patient accounting systems such as EPIC, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts, or Paragon
- Intermediate knowledge of the DDE Medicare claim system
- Intermediate knowledge of government rules and regulations related to healthcare billing
Compensation & Benefits
- Salary range: $20.00 to $23.00 per hour
- Actual compensation will vary based on geographic location, candidate experience, certifications, and skills
Equal Opportunity Statement
The employer is an Equal Opportunity Employer and does not discriminate based on race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity, or any other protected class under federal, state, or local law.
Location
This position may require compliance with state-specific employment laws where applicable.