Specialist-Collections II (Remote)

Spartanburg Regional Healthcare System•Spartanburg, SC

3d•Remote

About The Position

The Collections Specialist is responsible for managing and collecting accounts receivable for insurance carrier plan services billed through hospital and physician billing systems. The role handles timely, accurate claims follow-up and payer corrections to meet and exceed departmental cash collection and accounts receivable goals. Applicants must reside in one of the following states: Alabama, Arizona, Connecticut, Delaware, Florida, Georgia, Indiana, Kansas, Kentucky, Louisiana, Maryland, Michigan, North Carolina, Pennsylvania, Rhode Island, South Carolina, Virginia, West Virginia, or Wisconsin.

Requirements

High school diploma or equivalent.
At least 3 years of medical office or medical billing/collections experience in a hospital or centralized billing setting.
Knowledge of CPT, HCPCS, and ICD-9/10 codes.
Working knowledge of insurance explanations of benefits (EOBs) and comprehensive understanding of remittance and remark codes.
Familiarity with multiple payer requirements for claims processing.
Solid Microsoft Office skills, particularly Excel and Word.
Good communication skills.

Nice To Haves

Associate degree.
At least 4 years of experience in a centralized billing setting.
In-depth working knowledge and experience with insurance billing guidelines for commercial insurance, Medicare Part A and B, Medicaid, and managed care plans.
Experience with multiple-specialty billing, collections, and denials.

Responsibilities

Collect outstanding claims through direct payer contact, payer websites, and EDI/claims systems.
Research and resolve payment issues and errors for insurance balances.
Complete error corrections and insurance updates to facility and professional claims to resolve issues preventing payment.
Obtain insurance eligibility and benefit information from payers by phone, RTE, or web for proper claims filing.
Review smart edits and payer rejections and complete necessary rework to obtain reimbursement.
Work across claims eligibility, online payer claims, and accounts receivable management systems.
Escalate non-denial payer issues, including reviewing outstanding accounts receivable over 90 days, and share details with payers and management.
Work with multiple departments to obtain information needed to resolve outstanding accounts receivable.
Update and verify insurance records as needed to correct outstanding accounts.
Ensure claims are received and processing with payers within timely filing periods defined by departmental goals and insurance guidelines.
Present trends and issues to payers during monthly provider calls.
Gather payer information to submit payment research requests when payment has not posted to an account.
Produce reports and data in Excel as needed.
Use working knowledge of registration, payment posting, error correction, and other billing functions.
Exhibit professionalism and good customer service, and maintain confidentiality when handling sensitive information.
Respond to emails within 24 to 48 hours of receipt.
Manage time and work processes to meet organizational and departmental expectations.
Perform other duties as assigned.