Experienced Humana Insurance Collection Specialist

AIS Healthcare•Remote,

5d•Remote

About The Position

AIS Healthcare is seeking experienced and motivated Accounts Receivable Collection experts to join their dynamic team. This is a full-time, 100% remote opportunity. The AR Collection role is responsible for collection processes for Targeted Drug Delivery (TDD) services, which includes contract analysis, reimbursement, denial management, appeals, and resolving billing-related issues with insurance companies or other responsible parties for services rendered. The ideal candidate will possess an in-depth knowledge of collection practices related to billing and collection activities.

Requirements

3 to 5 years of medical insurance collection experience.
A high school diploma or general education degree (GED) equivalent is required.
3-5 years of healthcare industry experience required.
3-5 years of medical billing and collections experience required.
Ability to recognize, evaluate and exercise good judgment in solving complex situations and advising in accordance with laws and regulations.
Excellent verbal and written communication and relationship building skills with an ability to prioritize, negotiate, and work with a variety of internal and external stakeholders.
Strong work ethic with personal qualities of integrity and credibility.
Self-directed, detail oriented, conscientious, organized, and able to follow through.
Ability to deal in an organized manner with problems involving multiple variables within the scope of the position.
Tolerant of frequent interruptions and distractions from staff and other internal support teams.
Proficient in Microsoft Office, including Outlook, Word, and Excel.

Nice To Haves

Home Infusion, Intrathecal Pain Management experience preferred.

Responsibilities

Recognizes patients’ rights and responsibilities and supports them in the performance of job duties, respects patient’s rights to privacy and confidentiality.
Follows up on invoices submitted to ensure prompt and timely payment and escalates issues, as necessary.
Evaluates payments/denials received for correctness and ensures they are applied accordingly.
Identifies bad debt write-offs and A/R adjustments. Initiates write-offs and adjustments in accordance with policies and procedures.
Identifies any overpayments and/or duplicate payments and investigates and resolves accordingly.
Processes refund requests, in accordance with policies and procedures.
Maintains contact with other departments to obtain patient or insurance information needed for claim payment.
Responsible for understanding all procedures within regulatory mandates.
Ensures that the activities of the collection operations are conducted in a manner that is consistent with overall department protocol, and are following Federal, State, and payer regulation, guidelines, and requirements.
Makes calls to troubleshoot payment discrepancies and establish resolution.
Documents, in detail, phone calls, phone number, person spoken to, and call details on a consistent basis.
Consistently looks for areas to maximize claim reimbursement.
Resolves issues that created a denial within 5 days of receipt of denial.
Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
Maintains understanding of NDC (National Drug Code) numbers, metric quantities, and knowledge of infusion supplies.
Maintains a broad range of knowledge of insurance plans, medical terminology, billing procedures, government regulations, and medical codes.
Shares knowledge gained with other staff members and works as a team member.
Interacts with others in a positive, respectful, and considerate manner.
Performs other job-related duties as assigned.