Healthcare Collections Specialist

Agave Ridge Behavioral Health Hospital•Mesa, AZ

About The Position

This role involves managing outstanding claims with third-party payors, reviewing and correcting claim issues, and ensuring accurate payment processing. The specialist will utilize the claims clearinghouse, review explanations of benefits, and complete adjustment forms. Daily productivity will be managed through the patient accounting system, with a minimum target of 30-40 accounts worked per day. The position also requires prorating patient accounts, monitoring financial classes, reporting weekly overviews to the BOD, and participating in AR meetings. Additionally, the specialist will gather and interpret system data to initiate steps for payment and assist financial counselors with benefit eligibility matters.

Requirements

High school diploma or equivalent required.
Three or more years’ prior admissions and or collections experience in a hospital setting required.

Nice To Haves

Psychiatric experience preferred.

Responsibilities

Call and status outstanding claims with third party payors.
Review claims issues and make corrections as needed and rebill.
Utilize claims clearing house to review and correct claims. Resubmit electronically when available.
Review explanation of benefits to ascertain that claim processed and paid correctly.
Complete adjustment forms if any adjustments need to be made to an account and attach all supporting documentation.
Manage daily productivity via patient accounting system and productivity reports. Needs to maintain an average of 30-40 accounts worked per day minimum.
Prorate patient accounts and monitor that balance due is in the correct financial class.
Report an overview of the week to the BOD and participate in AR meetings.
Gather and interpret data from system and understands appropriate course of action to take and initiates time-sensitive and strategic steps resulting in payment.
Assist financial counselors as needed.
Alert Financial Counselors and Business Office Director of all benefit eligibility matters that suggest or challenge reimbursement.