Healthcare Collections Specialist II
About The Position
Evolve Treatment Centers provides intensive outpatient, partial hospitalization, and residential programs for teens ages 12 to 17 experiencing substance use and mental health disorders. The Healthcare Collections Specialist II manages outstanding healthcare accounts receivable, resolves payment issues, and provides professional service to support collections and revenue goals. The role requires healthcare billing and collections knowledge, assertive follow-up with insurance carriers, attention to detail, and compliance with applicable requirements and company procedures. Behavioral health experience is a plus.
Requirements
- Experience working in healthcare as a Collections Specialist, especially collecting behavioral health claims.
- 3–5 years of high-volume corporate collections experience.
- Knowledge of billing and collections procedures.
- Experience using online payer resources.
- Excellent phone etiquette and oral communication skills.
- Experience speaking with payors.
- Experience speaking with families and parents and collecting payments.
- Accounts receivable knowledge or experience.
- Strong attention to detail and goal orientation.
- Commitment to excellent customer service.
- Ability to work efficiently within deadlines.
- Excellent written and verbal communication abilities.
- Strong interpersonal skills and ability to work in a team environment.
- Ability to prioritize and manage multiple responsibilities.
- Adherence to policies and procedures outlined in the Employee Handbook.
- Proficiency with Microsoft Office products.
Nice To Haves
- Experience in behavioral health.
- Experience with KIPU and CollaborateMD.
Responsibilities
- Conduct daily patient advocate and parent follow-up.
- Follow up weekly on paid-to-patient, paid-to-deductible, and private-pay accounts.
- Prepare certified-mail packages once or twice a week.
- Manage Single Case Agreements (SCAs).
- Research and resolve complex claim denials, underpayments, payment discrepancies, contractual adjustments, coordination-of-benefits issues, and reimbursement disputes.
- Analyze Explanation of Benefits (EOBs) and Remittance Advices to verify claims were processed according to members’ plans.
- Identify denial reasons and pursue appeals to obtain claim payment.
- Make high-volume collection calls to insurance companies and use payer online resources to expedite follow-up and confirm claims are on file and processing.
- Prepare and pursue appeals, reconsiderations, and payer escalations within applicable filing deadlines.
- Follow EOB protocol and retrieve documentation to ensure paid accounts are closed.
- Use billing software to analyze rejection reasons, communicate findings, and request resubmission when billing or coding errors are identified.
- Identify and report changes and trends in carrier guidelines and reimbursement patterns.
- Complete special projects and other duties assigned by management.
- Correspond with third-party rate negotiation companies to expedite claims.
- Access the EMR, retrieve medical records, and prepare records for timely submission according to protocol.
- Follow documentation protocol, annotate accounts, and report appropriately.
- Organize daily and weekly production/action reports in the file share.
- Provide excellent customer service and professional, collaborative support while working toward team goals.
- Prepare, review, and send client statements.
- Collect patient balances.
- Comply with HIPAA rules and regulations.
- Perform office, facilities, and other assigned duties.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
