Regional Collection Specialist

PDS Health•Golden, CO

About The Position

The primary purpose and function of the Regional Collections Specialist is to effectively assist in collections; coach and train Operation Managers (OM) on the Aging Collection Report to ensure that claims are properly billed to the patients and insurance companies, and ultimately paid. This position partners with the Central Billing Office (CBO), and is proactive in its efforts to ensure insurance companies are billed correctly and promptly, as well as receivables are collected effectively in each office.

Requirements

Equivalent to high school diploma or general education degree (GED), required.
3-4 Years of related experience in the dental field, required.

Nice To Haves

Bachelor's degree and 3 to 5 years of related experience, preferred.
Prior experience as a claims auditor within a group practice environment, preferred.
QSI (Quality Systems Inc.) experience, preferred.

Responsibilities

Weekly, check all portals; (e.g. Request for Information (RI), and Credit and Claims) to ensure that any missing information is obtained, so that the claims are billed properly; review and take necessary action in the credit portal to ensure meeting Company's credit goals, review and take necessary action in the claims portal for any past due adjustment requests from CBO.
Process the Aging Collection Report ensuring complete accounts are properly billed to the patient and insurance. Not just reviewing a point in time date of service, but examining accounts in its entirety.
Read and analyze Explanation of Benefits (EOB) statements and adjust accounts according to PDS claims processing criteria, including; claim tracing and contacting insurance carriers and/or ensuring patients balances are secured as appropriate.
Document all actions on accounts in the system. Maintain effective, ongoing communication with CBO on accounts handled.
Provide ongoing coaching and training to OM and Benefit Coordinator (BC) one-on-one, or in groups as appropriate.
Meet monthly with OMs of assigned region to assist with working though credit and collection reports to increase office collection rate.
Communicate trends and suggestions to improve processes to OMs, Regional Managers (RM), Regional Partners (RP) and CBO. Meet with RM at end of month to review accounts sent to collections over Company approval limits and claim adjustments outside of Company policies.
Develop systematic approach for process improvement, and effectively coordinate and communicate changes and enhancements.
Participate in CBO operations call and any other meetings as required.
Ensure compliance with Company policies as well as State, Federal and other regulatory bodies.
Maintain an appropriate professional appearance and demeanor in accordance with Company policy.
Other duties as assigned by management.