Hospital A/R Collector

USPI•Dallas, GA

5d•$16 - $23

About The Position

The Hospital A/R Collector reports to the Hospital Collections Supervisor and uses knowledge of medical collections, accounts receivable, insurance billing and verification, denial processing, appeals, and EOB review to resolve outstanding surgical claims and obtain maximum reimbursement. The role includes managing payer and patient accounts, reviewing medical documentation and reimbursement accuracy, and resolving claims in accordance with payer contracts and coverage rules.

Requirements

Strong knowledge of medical collections, accounts receivable, insurance billing and verification, denial processing, appeal submission, and EOB review.
Knowledge of Medicare, Medicare Advantage, Medicaid, and commercial payers.
Ability to review medical documentation to justify medical necessity.
Knowledge of payer contracts, fee schedules, or summary plan documents for assessing reimbursement accuracy.
Knowledge of Medicare, state Medicaid, and local coverage determinations for claim resolution.

Responsibilities

Follow up on and resolve outstanding accounts receivable, including unpaid, underpaid, and denied claims for all payers, including self-pay, to obtain maximum reimbursement.
Manage daily work queues and prioritize high-dollar claim balances.
Follow up with insurance companies regarding denied claims and appeals; verify eligibility and benefits by phone or online.
Review payer contracts to ensure claims have processed correctly.
Review and work incoming insurance and patient correspondence, including refund requests.
Prepare and write medical-necessity appeals when appropriate, or provide requested medical documentation.
Review medical documentation to support medical necessity.
Review patient balances for accuracy and follow up with patients to obtain payments.
Review insurance payments and determine reimbursement accuracy based on contracts, fee schedules, or summary plan documents.
Apply Medicare, state Medicaid, and local coverage determination knowledge to resolve claims.
Negotiate procedure payment amounts with Third Party Administrators for out-of-network providers.
Recommend adjustments when applicable or recommend refunds for overpayments to insurance carriers or patients, with appropriate documentation.