Medical Billing & Collections Specialist

Logan Health

2d•Remote

About The Position

The Medical Billing & Collections Specialist plays a vital role in ensuring the accuracy, completeness, and timeliness of claim submissions, closely monitoring claim statuses, investigating rejections and denials, and documenting all account activities. This role requires strong critical thinking skills and an in-depth understanding of insurance eligibility, payment methodologies, and contractual adjustments based on government regulations. Additionally, the specialist must demonstrate proficiency in billing systems to optimize efficiency, ensure compliance, and facilitate the seamless processing of claims. With a keen attention to detail and expertise in navigating complex insurance requirements, the Medical Billing & Collections Specialist supports operational excellence and contributes to the organization’s financial health.

Requirements

1+ year(s) of experience in a business, medical, or clinical environment.
Proficiency in Electronic Medical Record (EMR) billing systems.
Strong knowledge of medical terminology and health insurance guidelines.
Fluent in English, both spoken and written.
Minimum of one (1) year experience in a hospital or medical office setting preferred.
Proficient with basic accounting and ten-key by touch preferred.
Prior experience with business mathematical tasks and correspondence preferred.
Excellent interpersonal and customer service skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy.
Possess and maintain computer skills to include working knowledge of Word, Outlook, Excel, and ability to learn other software as needed.
Possess ability to maintain confidentiality and understand HIPAA guidelines and other applicable federal laws.
Excellent organizational skills, detail-oriented, a self-starter, possess critical thinking skills and be able to set priorities and function as part of a team as well as independently.
Commitment to working in a team environment and maintaining confidentiality as needed.
Excellent verbal and written communication skills including the ability to communicate effectively with various audiences.
Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy.
Possess and maintain computer skills to include working knowledge of Microsoft Office Suite and ability to learn other software as needed.

Nice To Haves

2+ years of experience in a business, medical, or clinical environment.
Experience with specific EMR systems, including Meditech and Cerner.
Proficiency in Microsoft Office Suite, particularly intermediate skills in Excel (e.g., data entry, formulas, basic functions).
Ability to work effectively in a fast-paced, dynamic environment with strong time management and organizational skills.
Demonstrated ability to prioritize tasks and complete work with minimal supervision.
Proven ability to build and maintain professional relationships.
Consistent and reliable attendance as scheduled by leadership.
Proficiency in Excel preferred.

Responsibilities

Process claims to appropriate primary, secondary, and/or tertiary insurance company according to insurance guidelines.
Perform follow-up on unpaid insurance accounts identified through aging reports.
Process appeals when appropriate.
Process refund requests.
Identify trends, and carrier issues relating to billing and reimbursements, report findings to leadership.
Maintain Privacy & Confidentiality of patient information and organizational operations.
Responsible for learning, understanding and following payer guidelines.
Reallocate misapplied payments and adjustments.
Work special assignments when needed.
Analyzes and interprets account data to facilitate timely claim and payment resolution as applicable to assigned area(s).
Collaborates and/or refers unresolved issues and escalates to appropriate party.
Posts payments and adjustments utilizing the appropriate fee schedule, policy and/or procedures in accordance with patient statements, remittance advices, insurance carriers, electronic downloads, etc. and as applicable to assigned area(s).
Identifies credits, variances and trends.
Performs appropriate action to facilitate resolution in a timely manner.
Documents all communication, both written and verbal, in an accurate, clear and factual manner.
Completes account maintenance review to ensure account information is accurate within billing system.
Acts as a Patient Accounting liaison between patients, clients, providers, payers, vendors and other Logan Health departments as applicable to assigned area(s).
Interprets explanation of benefits (EOB) message codes, validates payer processing and identifies potential payment discrepancies as applicable to assigned area(s).
Effectively manages assigned work in accordance with team expectations, department productivity, and quality standards and as applicable to assigned area(s).
Provides exceptional customer service to stakeholders for questions and concerns.
Responsible for all Medicare, Medicaid, and Case Management insurance denials processing as applicable to assigned area(s).
Responsible for all insurance appeals and works with appropriate stakeholders to ensure completion as applicable to assigned area(s).
Serves as point of contact for quotes, equipment authorization, etc. as applicable to assigned area(s).
Maintains regular and consistent attendance as scheduled by department leadership.