Collections Specialist

McGee, Dean A Eye Institute • Oklahoma City, OK

96d

About The Position

The Collections Specialist is responsible for ensuring accurate billing, timely submission of electronic and/or paper claims, monitoring claim status, researching rejections and denials, documenting related account activities, posting adjustments and collections of Medicare, Medicaid, Medicaid Managed Care, and commercial insurance payers. The Collections Specialist must possess critical thinking skills and understanding of Medicare, Medicaid eligibility requirements as well as commercial insurance payer payment methods to correctly record contractual adjustments based on payer contracts or government regulations. In addition, the Collections Specialist must demonstrate proficiency with billing system to ensure all functionality is utilized for the utmost efficient processing of claims.

Requirements

• High School Diploma or equivalent required.
• Customer service experience and basic computer skills required, preferably in a Windows environment with electronic medical records software.

Nice To Haves

• 2 or more years Epic System experience working in revenue cycle.
• Medicare and Medicaid claims processing knowledge.
• Medical terminology or other previous medical office experience desirable.
• Knowledge of Ophthalmic terminology.
• Pre-certification experience.
• Continuing education.

Responsibilities

• Have understanding and working knowledge of the EPIC PB/HB revenue cycle system.
• Work accounts from an Epic work queue on a daily basis.
• Responsible for resolution and collection of outstanding insurance claims thru the completion of the adjudication process.
• Must have Medicare / Medicaid working knowledge and billing experience.
• Must have relative and current experience working with commercial and other non-government payers thru the billing and denials process.
• Understanding and knowledge of reading and interpretation of a RA (remittance advice) and EOB (explanation of benefits).
• Experience and knowledge of researching payments and denials on multiple payer websites.
• Must be experienced in calling any and all payers if the online portals information is incomplete or additional clarification is required for an outcome.
• Able to download medical records or other documentation on the portal upon request, for payment of insurance claims (including colored photos).
• Understanding and skill set in submitting written appeals to insurance companies disputing denials.
• Adjudicate the EOB and RA if additional adjustments are necessary and were not applied on the original posting of the EOB/RA.
• Process patient and insurance refunds as necessary and efficiently.
• Communicate effectively with supervision, accurately and efficiently, while handling high claim volume.

What This Job Offers

• Job Type: Full-time
• Industry: Hospitals
• Education Level: High school or GED
• Number of Employees: 101-250 employees