Collections Specialist

Evoraa Healthcare•Peachtree City, GA

10d

About The Position

The Collections Specialist is a vital member of the Compass Revenue Solutions. The Collections Specialist is under the supervision of the Director of Finance. The Collections Specialist is responsible for collections of outstanding accounts receivable dollars from the insurance payers.

Requirements

Understanding of explanation of benefits, and/or remittances.
Knowledge of departmental guides, payer rules, templates and platforms.
Ability to work on correspondence denials.
Skill in identifying and resolving problematic claims.
Specialized knowledge of contracts, regulatory or contractual billings guidelines.
Ability to analyze, identify and resolve issues causing payer payment delays.
Skill in identifying root causes for claim denials and underpayments.
Ability to identify and notate duplicate billings, coordination of benefits, medical records or clinical documents needed.
Proficiency in using payer website tools for claim and remittance functions.
Experience with Excel spreadsheets.
Ability to communicate results.
Up-to-date knowledge of payer policy updates and internal billing policies and procedures.
Ability to prioritize workflow and work within deadlines.
Ability to meet productivity and quality standards.
Knowledge of Health Insurance Portability and Accountability Act (HIPAA) standards for protecting patient health information (PHI).

Responsibilities

Follow-up with payers to ensure timely resolution of all outstanding claims, via phone or online resources.
Review and understand explanation of benefits, and/or remittances.
Know where to locate all departmental guides, payer rules, templates and platforms.
Work on correspondence denials received from clients, internal operations or portals.
Maintain thorough identification and resolution of problematic claims.
Utilize specialized knowledge of contracts, regulatory or contractual billings guidelines to determine an account’s ability to pay after initial denial from payer.
Analyze, identify and resolve issues causing payer payment delays.
Identify root causes for claim denials, underpayments and document the action taken.
Identify and notate duplicate billings, coordination of benefits, medical records or clinical documents needed from the payers to expedite payment of insurance claims.
Communicate with AR Director and Team Lead in identification and resolution of denial trends, including timely escalation, and regular updates.
Identify and communicate billing discrepancies to Team Lead and AR Director.
Stay up-to-date and utilize available payer website tools for claim and remittance functions.
Assist with special projects by utilizing excel spreadsheets, and the ability to communicate results.
Communicate problems, questions and/or concerns to AR Director timely.
Keep current knowledge of payer policy updates and internal billing policies and procedures.
Prioritize workflow and work within deadlines.
Meet productivity and quality standards as set by management.
Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
Fulfill other requests by AR Director, and/or Team Lead.