Follow Up & Collections - Billing Specialist IV - Non NSA

PHI Health•Phoenix, AZ

16h•Onsite

About The Position

Under the direction and supervision of the Team Operational Coordinator (TOC), the Follow Up & Collections position performs collection tasks using a high level of knowledge, skills, abilities, and experience. The specialist manages patient accounts from resubmission through final resolution, identifies and addresses denials through appeal letters, verifies account balances against payer contract terms, and follows payer-specific rules and guidelines to obtain appropriate reimbursement in a timely manner. The role supports patient and insurance collections, including account review, claims follow-up, payment and contractual reviews, insurance coverage confirmation, and patient financial discussions. The specialist also analyzes payer trends, researches and communicates billing policies, supports projects, and serves as a resource for billing staff. The position is based in Phoenix, Arizona, with a 5-and-2 schedule. It is designated Safety Sensitive for purposes of the Arizona Medical Marijuana Act.

Requirements

High school diploma or GED equivalent.
Previous medical billing or collections experience with progressively increasing complexity and responsibilities.
Knowledge of general office procedures and use of office equipment.
PC skills and demonstrated proficiency in Microsoft Word, Excel, and medical billing software.
Prior experience using email and the web.
Ability to pass a pre-placement drug test and background screen.
Working knowledge of HCPCS, CPT, ICD-9, ICD-10 codes, medical terminology, and clinical documentation.

Nice To Haves

Some college.

Responsibilities

Act as a patient advocate by obtaining information and support for claims processing and discussing outstanding patient balances and resolution options.
Analyze adverse billing, collections, and payer trends; report or present findings and suggested solutions to management.
Assist with special projects related to payer issues or overall collections shortfalls.
Contact insurers consistently and knowledgeably to obtain timely payments, escalating issues to supervisors or grievance departments when appropriate.
Categorize and quantify payer payment issues for resolution and management reporting.
Maintain customer focus and professional relationships while communicating with patients, first responders, facilities, PHI agencies, entities, insurers, and attorneys.
Understand payer fee schedules, enrollment requirements, and PHI payer and facility contracts.
Perform insurance collection activities, including payment-in-full negotiations, overpayment reviews and approvals, correspondence follow-up, and handling insurance types and classes in accordance with PHI policies and procedures.
Draft correspondence to patients and payers, including first-level appeals for technical denials, and identify accounts for referral to the Appeals Department.
Handle patient calls involving financial screening for charity programs, payment plans, discounts, and resolution of patient complaints.
Organize and prioritize work using online tools and required systems and software to support production goals.
Perform financial screening for payment-in-full negotiations, establish payment plans, and assess eligibility for PHI's charity program in accordance with company policies.
Conduct in-depth account reviews, including skip tracing, correspondence research, secondary claims billing, payment review, contractual adjustments, and updates to insurance or demographic information.
Identify, collect, and confirm insurance coverage, including prior authorization, third-party liability, and coordination of benefits.
Provide leadership and serve as a resource to management by assisting, training, and supporting PFS Billing Staff.
Research, evaluate, and communicate payer-specific billing policies, guidelines, and statutory regulations to the team.
Respond to, monitor, and track claims and correspondence, prioritizing work to meet production standards.
Review patient accounts regardless of age, status, or payer and determine appropriate handling.
Review and interpret explanations of benefits to assess contractual compliance, payment accuracy, patient responsibility, denied or reduced coverage, and required follow-up.
Coordinate projects and prioritize assignments individually and at the departmental or team level.
Understand payer billing requirements and help ensure claims are accurate before submission; train staff on new and established payer requirements.
Apply insurance regulations and guidelines, including CMS guidelines, when discussing slow payments, underpayments, and denials with payers and pursuing compliant payment.
Comply with Company HS&E policies and procedures and support company Safety Management Systems activities and Destination Zero.
Participate in ongoing training and expand duties as responsibilities increase.
Perform other duties and responsibilities as assigned.