Position Summary

Medical Insurance Collections Specialist is responsible for the resolution and collection of problematic and aged insurance claims on behalf of clients. The daily functions include contacting insurance carriers for claim status updates, resubmission of claims, preparing and submitting appeals when necessary, etc. Additional responsibilities include routine follow-up on rejections and denials, communicating with insurance carriers/third parties.

Essential Functions

• Ability to meet monthly productivity and performance metrics

• Identify claim denial causes

• Ability to handle complex calls; identifying the problem and escalating issues as needed

• Work accounts based on aging report within the claims system

• Determines most effective means of collection for each account, applies standard due diligence practice to collect monies owed, composes correspondence requiring knowledge of procedure and practices in collections and sends a variety of standard collection letters

• Compiles information and prepares a variety of reports on collection activities for business office manager, such as: outstanding and current accounts standings

• Maintain proper notation in claims system

• Strong interpersonal and communication skills with an ability to work effectively with a wide range of people, teams, managers, supervisors, and third party payers

• Ability to make sound and evaluative judgments; strong organizational problem solving and analytical skills

• Work as a team member within the department

• Document work processes as required

• Perform other duties as assigned

Experience Required

• More than 2 years in Medical Billing and Collections experience.

• Knowledge of Billing Guidelines and ICD-10, CPT and HCPCS coding.

• Experience with Medicare and Medicaid billing guidelines and rules, insurance reimbursement methods, the claims appeal process.

• Understanding of managed care contracts and capitation payments.

• Experience with billing and collections of physician commercial insurances.

• Computer proficiency in Word, Excel, Outlook, along with general knowledge of internet research and medical billing systems.

• Personal Effectiveness/Credibility.

• Confidentiality.

Skills and Abilities

• Use language and mathematical skills to analyze and interpret reports and related material.

• Use special record keeping procedures.

• Recognize errors in recorded information.

• Perform routine and repetitive work.

• Excellent computer skills.

• Knowledge of 3M Encoder.

• Medical Terminology.

• Principles of disease.

• Use of appropriate ICD-10 codes and CPT (Current Procedure Terminology) for diagnosis and procedures.

• Anatomy and Physiology.

• Medical Terminology.

Physical Demands

Light Work: Exerting up to 20 pounds of force occasionally for up to 1/3 of the time and/or up to 10 pounds of force occasionally for up to 1/3 of the time to move objects. Requires walking or standing to a significant degree, or requires sitting most of the time but entails pushing and/or pulling of arm or leg controls, or requires working at a production rate pace entailing the constant pushing and/or pulling of material even though the weight of those materials is negligible.

Environmental Conditions

Inside: Protection from weather conditions but not necessarily from temperature changes.

Reasoning Development

Apply principles of rational systems to solve practical problems and deal with a variety of concrete variables. Interpret instructions furnished in written, oral, diagrammatic form.

Mathematical Development

No special computation skills are necessary. Basic mathematical skills and concepts will be utilized for patient payment needs and calculate their care expenses.

Language Development

Reading: Read and understand instructions, safety rules, legal documents and the components of medical records.

Writing: Write reports with proper format, punctuation, spelling and grammar, using all parts of speech.

Speaking: Speak with poise, voice control, and confidence, respect, using correct and English and well-modulated voice.

Relationships to Data, People and Things

Data: Compiling: Gathering, collating or classifying information about data, people, or things. Reporting and/or carrying out a prescribed action in relation to information are frequently involved.

People: Speaking-Signaling: Talking with and/or signaling people to convey or exchange information.

Things: Operating-Controlling: Starting, stopping, controlling and adjusting the progress of machines or equipment. Operating machines involves setting up and adjusting the machine or materials as the work progresses. Controlling involves observing progress of operations and turning devices to regulate reactions of materials.