Medical Collection Specialist

Gastromed, LLC•Coral Gables, FL

About The Position

The Medical Collection Specialist will be responsible for identifying denial trends, processing rejections/denials, and appealing denied claims. This role requires in-depth knowledge of ICD10 coding, CPT, HCPCS, CMS 1500 FORM, Super Bill, Electronic Claims Submission, Clearing House Operations, EOB, Payments, Denials, and appeals. The specialist will also answer patient and insurer billing questions, resolve disputes, and communicate with insurance companies for claim payments. Maintaining accurate chart notes and following up on patient denials are key responsibilities. The position requires the ability to work independently with minimal supervision and maintain patient confidentiality.

Requirements

High School Diploma required.
Minimum 1 years of experience in billing and/or medical collections
Pathology Billing experience
Bilingual English/Spanish Preferred; must be able to read, write and speak English.
Computer Knowledge: MS word, MS Excel internet, document with Electronic Health Records and/or authorization system with minimal typing/spelling errors, send emails and faxes.
In depth knowledge of ICD10 and HCPCS coding.
Excellent communication, Customer Service and telephone skills.
Strong organizational skills and ability to multi-task effectively.
Must be able to work independently with minimal supervision.
Able to respect and maintain patient confidentiality at all times.
Functions with minimal direct supervision.
Must be dependable and conduct him/herself in a professional manner.
Demonstrates skill in use of personal computers, various programs and applications required to competently execute job duties.
Must be able to follow policies and procedures.

Nice To Haves

ECW experience preferred.
CPC Certified Preferred

Responsibilities

Identify denial trends and make recommendations for resolutions.
Process rejections/denials and resubmit claims as needed.
Appeal denied claims and follow up as needed.
Answer patients’ or insurers’ billing questions and resolve issues or disputes in a timely manner.
Review patient information to determine or identify claim denial causes.
Communicate with insurance companies for claim(s) payment.
Request correct adjustment to resolve outstanding account balances.
Maintain accurate and detailed chart notes in the system.
Follow- up on patient denials prior to the payer’s appeal deadline.
Perform any other duties as assigned.