Medical Insurance Collector

Tyvan LLC

About The Position

The Medical Insurance Collector handles complex denials, prepares appeals, and takes other necessary actions to resolve outstanding balances for BCBS, UHC, Aetna/Cigna, and self-funded or commercial providers in professional and facility fee environments. The facilities are out of network with all payers. The role requires in-depth knowledge of collection processes and medical insurance policies, strong written and verbal communication, and the ability to multitask, solve problems, and manage time effectively. The collector investigates and responds to payer inquiries, corrects claim errors, follows up on accounts for timely filing and payment, reviews payer policy changes, and addresses payment errors. The position also includes reviewing EOBs, initiating appeals, resolving insurance requests and concerns, and ensuring payment meets the qualified payment amount required by the No Surprises Act. The role requires critical decision-making and meeting departmental goals. After the remote transition is completed, the employee must be able to work effectively from home.

Requirements

At least 3 years of medical insurance collection experience, with an emphasis on Medicare insurance collections.
3–4 years of previous billing experience, with an emphasis on Medicare billing.
Strong knowledge of BCBS, UHC, Aetna/Cigna, and self-funded or commercial insurance providers.
Knowledge of electronic medical records, collections, payment posting, reimbursement, billing, and hospital experience.
Required knowledge of EOBs, HIPAA, ICD-10 codes, and CPT codes.
Knowledge of payer systems.
Experience with the DDE system and Novitasphere.
Working knowledge of the CMS 838 credit balance report.
Ability to work effectively from home after the remote transition is completed.
Organized, self-sufficient, analytical, and detail-oriented.
Excellent written and verbal communication skills, multitasking ability, problem-solving skills, and effective time management.

Nice To Haves

Previous experience in a facility setting.

Responsibilities

Investigate and respond to inquiries from payors.
Research errors and make corrections to support clean claim production and submissions.
Follow up on accounts to ensure timely filing and prompt payment.
Actively review billing and collection policy changes for assigned payers.
Follow up on payment errors, review posting, and calculate allowable amounts before approving patient statements.
Review insurance EOBs and initiate appeals as necessary.
Resolve insurance requests, inquiries, and concerns expediently and respectfully.
Work accounts to ensure payment meets the qualified payment amount required by the No Surprises Act.
Use critical decision-making to fulfill the position’s expectations.
Meet and exceed departmental goals set by the company and department manager.
Function as a subject matter expert for Medicare and for clinical, medical necessity, authorization, non-covered, and underpayment appeals.