Hospital AR Collector – Level III

USPI•Dallas, TX

About The Position

The Level III - High Dollar Collector is responsible for the follow-up and resolution of high-balance Insurance accounts. This role requires extensive knowledge of insurance payers, appeals processes, clinical policies, and medical billing practices. The ideal candidate will be detail-oriented, proactive, and skilled in resolving complex account issues to ensure timely and accurate reimbursement.

Requirements

Extensive knowledge of insurance payers, appeals processes, clinical policies and medical billing practices.
Detail-oriented, proactive, and skilled in resolving complex account issues.
Extensive knowledge of Fee Schedules and Payor Contracts.
Ability to write targeted appeals and reconsiderations for denied or underpaid claims.
Ability to review medical records, summary plan documents, and contracts to determine medical necessity.
Knowledge of all payers including BCBS, Aetna, UHC, Cigna, Commercial, and Managed Medicare.
Ability to review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents.
Ability to work closely with cross functional departments such as billing, coding, and payment posting to resolve account discrepancies.
Ability to facilitate effective communication with insurance carriers, patients, and internal departments to resolve outstanding balances.
Ability to work a minimum of 30 accounts daily with > or = 90% accuracy rating and meet department productivity standards.

Responsibilities

Completes in-depth reviews and timely follow ups on high-dollar accounts (typically $10,000 and above) to ensure claim resolution to obtain maximum reimbursement.
Identifies trends or issues causing delays or denials, escalating to all appropriate parties.
Must write targeted appeals and reconsiderations for denied or underpaid claims.
Reviews medical records, summary plan documents, and contracts to determine if we have cause for medical necessity.
Leverages knowledge of all payers BCBS, Aetna, UHC, Cigna, Commercial, and Managed Medicare.
Reviews insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents.
Extensive knowledge of Fee Schedules and Payor Contracts
Works closely with cross functional departments such as billing, coding, and payment posting to resolve account discrepancies.
Facilitate effective communication with insurance carriers, patients, and internal departments to resolve outstanding balances
Works a minimum of 30 accounts daily with > or = 90% accuracy rating; must meet department productivity standards.