Experienced BCBS Insurance Collections Specialist

AIS Healthcare•Remote,

1d•Remote

About The Position

AIS Healthcare is seeking an experienced Accounts Receivable Collections Specialist to handle collection processes for Targeted Drug Delivery services. The role includes contract analysis, reimbursement, denial management, appeals, and resolution of billing-related issues with insurance companies or other parties responsible for payment. The position requires in-depth knowledge of billing and collection practices and is full-time and 100% work from home. The specialist follows up on invoices, evaluates payments and denials, processes adjustments and refunds, investigates overpayments and duplicate payments, and works to maximize claim reimbursement. The role also requires detailed documentation, coordination with other departments, compliance with applicable regulations and HIPAA requirements, and collaboration with coworkers and stakeholders.

Requirements

High school diploma or GED equivalent.
3–5 years of healthcare industry experience.
3–5 years of medical billing and collections experience.
Ability to recognize, evaluate, and use good judgment to solve complex situations and provide advice in accordance with laws and regulations.
Excellent verbal and written communication and relationship-building skills, with the ability to prioritize, negotiate, and work with varied internal and external stakeholders.
Strong work ethic, integrity, and credibility.
Self-directed, detail-oriented, conscientious, organized, and able to follow through.
Ability to handle problems involving multiple variables in an organized manner.
Ability to tolerate frequent interruptions and distractions from staff and internal support teams.
Proficiency in Microsoft Office, including Outlook, Word, and Excel.

Nice To Haves

Home Infusion experience.
Intrathecal Pain Management experience.

Responsibilities

Recognize and support patients’ rights and responsibilities, including their rights to privacy and confidentiality.
Follow up on invoices to ensure prompt payment and escalate issues as needed.
Evaluate payments and denials for correctness and ensure they are applied appropriately.
Identify bad debt write-offs and accounts receivable adjustments and initiate them according to policy.
Identify and investigate overpayments and duplicate payments, and resolve them appropriately.
Process refund requests in accordance with policies and procedures.
Contact other departments to obtain patient or insurance information needed for claim payment.
Understand procedures within applicable regulatory mandates and conduct collection activities in accordance with department protocols and Federal, State, and payer requirements.
Make calls to troubleshoot payment discrepancies and establish resolutions.
Document phone calls consistently, including the phone number, person spoken to, and call details.
Look for opportunities to maximize claim reimbursement.
Resolve issues that caused a denial within five days of receiving the denial.
Maintain confidentiality and adhere to HIPAA guidelines and regulations.
Maintain knowledge of NDC numbers, metric quantities, and infusion supplies.
Maintain knowledge of insurance plans, medical terminology, billing procedures, government regulations, and medical codes.
Share knowledge with other staff members and work as a team member.
Interact with others in a positive, respectful, and considerate manner.
Perform other job-related duties as assigned.