Medical Collections Specialist (BCBS)

Midwest Orthopaedics at Rush•Westchester, IL

6d•$22 - $24•Remote

About The Position

Midwest Orthopaedics at Rush is seeking a full-time Collections Specialist to join their team. This role is responsible for processing insurance claims, managing patient accounts, resolving unpaid or rejected claims for orthopedics patients, resolving overpaid claims, capturing and investigating denial trends, and collaborating with the team lead and/or management to help resolve challenging claims. The specialist will maintain accurate claim and account information, respond to account inquiries from both the patient and the practice, and document all patient interactions. Expertise in BCBS payor is required. This position offers the opportunity to work remotely, with flexibility to travel to the corporate office in Westchester, IL for training and as needed for team meetings.

Requirements

High School Diploma or equivalent
3-4 years of related experience in a business office or on a revenue cycle team
Expertise in government, commercial and/or third party payor claims submission, denial resolution, and appeals processes
Experienced with patient accounting systems – Athena preferred
Medical terminology required for accurate claims processing
Knowledge of CPT, HCPCS, and ICD coding systems

Nice To Haves

Associates or Bachelor’s Degree preferred
Preference given for physician or medical group CMS 1500 experience

Responsibilities

Analyzes authorizations, claims, explanation of benefits, correspondence, payor website and/or any additional information necessary to identify the next appropriate action toward payment resolution.
Follows commercial payor guidelines to ensure complete and timely follow-up on open balances for assigned payors or accounts in a timely manner.
Performs appeals, underpayment appeals, and disputes by following commercial, payor appeals guidelines or contracted terms.
Utilizes payor contracts and fee schedules to perform underpayment appeals or collaborates with the practice to obtain medical necessity appeals documentation.
Assists with tracking appeals outcomes.
Contacts patients or appropriate payor representatives via phone or electronically to resolve claims and/or coordinate benefits and submits claim in the correct filing order.
Works to identify other payors when possible and ensures all payors and filing order is correct in the practice management system.
Collaborates with the team lead to identify patterns and interpret denial trends.
Notifies Manager when insurance plans deny services, which are covered based on the contract terms, government regulations, third party agreement or patient’s benefit plan.
Works to minimize write-offs by exhausting all resolution options and performing thorough research/review of all appropriate resources.
Adjusts account or requests write-offs adhering to MOR policies and procedures.
Reviews denial reports and makes recommendations for billing or claim submission changes based on claim denials.
Research payor and government websites and/or medical resources, to identify payor claim requirements required to resolve open accounts receivable.
Collaborates with Coding Team or physician to resolve coding related denials and submits all coding related corrected claims and/or appeals.
Targets and reports any internal procedures or processes that may negatively impact or increase days in accounts receivable or delay claims resolution.
Interact with patients and commercial payors to respond to billing requests as appropriate.
Assists call center representatives with physician practice or patient requests by providing claim information and/or claim status to call center representative to correctly respond to patients.
Meets productivity and quality standards.
Documents using standardized note format all payor, attorney, and/or third party follow-up and account resolution activities in the practice management system.
Remains current with trends, regulatory requirements, and business strategies related to the revenue cycle.
Operates in compliance with all local, state and Federal laws as well as Company policy and compliance standards.
Other duties and responsibilities as assigned.