Revenue Cycle Specialsit-Collector

ESSENTIALS DUTIES AND RESPONSIBILITIES:

·         Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers including self-pay to obtain maximum reimbursement.

·         Manage daily work queue to prioritize high dollar claim balances.

·         Review & work incoming insurance and patient correspondence including refund requests.

·         Send appeals when appropriate or provide the requested medical documentation.

·         Ability to review medical documentation to justify medical necessity.

·         Take incoming patient phone calls to resolve inquiries, billing issues, or outstanding balances.

·         Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents.

·         Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD’s) for claim resolution.

·         Negotiate payment amounts for procedures with Third Party Administrators for out of network providers.

·         Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.

Required Skills:

·                      2+ years of revenue cycle 

• Ability to read and interpret insurance explanations of benefits and managed care contracts.
• Must communicate effectively, both verbally and in writing, with internal and external clients.
• Must be able to multi-task and handle competing priorities while meeting or exceeding deadlines.
• Knowledge or experience working with a variety of health care insurance payers is preferred.
• High School Diploma or equivalent.

General knowledge of the healthcare industry insurance/EOB payment process