Overview
This role involves performing collection follow-up on outstanding insurance balances, identifying claim issues, and ensuring timely resolution in compliance with government and managed care contract terms. The Collections Specialist I will communicate effectively with insurance payers, document account activity, and adhere to applicable regulations to support revenue cycle operations.
Responsibilities
- Follow up on outstanding insurance balances within required timeframes to obtain payment confirmation or necessary documentation.
- Document all actions taken on accounts within the appropriate system to ensure a clear and traceable resolution process.
- Make the required number of outbound calls to insurance payers while maintaining professional and courteous communication.
- Handle and resolve incoming correspondence within five days of receipt, updating the system with relevant information.
- Analyze assigned accounts using systems such as AS400, Meditech, Accurint, Cerner, directory assistance, and credit reports to maximize collection efforts.
- Process inbound and outbound calls professionally, providing exceptional customer service while resolving outstanding balances.
- Ensure proper application of account dispositions and follow self-pay policies and procedures.
- Adhere to all local, state, and federal laws and regulations, including FDCPA, TCPA, FCRA, CFPB, PCI, UDAAP, and HIPAA compliance standards.
- Perform other duties as assigned.
- Maintain regular and reliable attendance.
- Comply with all organizational policies and standards.
Qualifications
- High School Diploma or GED required.
- Associate Degree in Business, Finance, Healthcare Administration, or a related field preferred.
- 0-2 years of experience in medical collections, accounts receivable, billing, or healthcare revenue cycle operations required.
- Experience with insurance follow-up, claim resolution, and payer communication in a healthcare setting preferred.
Knowledge, Skills, and Abilities
- Strong understanding of medical collections processes, payer reimbursement policies, and insurance claim resolution.
- Proficiency in electronic medical record (EMR) systems, patient accounting systems, and collections software.
- Knowledge of insurance contracts, denials management, and accounts receivable workflows.
- Excellent problem-solving and analytical skills to research and resolve outstanding claims.
- Effective verbal and written communication skills to interact with insurance payers, patients, and internal teams.
- Strong attention to detail with the ability to document account activity accurately.
- Ability to work independently in a fast-paced environment while meeting productivity and quality standards.
- Knowledge of regulatory compliance, including HIPAA, FDCPA, and applicable healthcare finance laws.
Compensation and Benefits
- Comprehensive health coverage including medical, dental, and vision plans.
- 401(k) retirement plan with matching contributions.
- Student loan repayment assistance up to $10,000.
- Educational tuition assistance.
- Competitive pay and full benefits package designed to reward expertise and dedication.
Location
North Knoxville Medical Center