Specialist-Collections II

Spartanburg Regional Medical Center - Spartanburg, SC

Spartanburg, SC

Hospitals

About the position

The Collections Specialist is responsible for managing and collecting on accounts receivables for all insurance carrier plan services billed through the hospital/physician billing systems. This position is responsible for timely and accurate claims follow up and payer corrections to meet and exceed our departmental cash collection and AR goals.

Responsibilities

• Collections of all outstanding claims by direct payer contact, utilization of payer websites, and EDI/Claims system
• Research and resolve all payments issues/errors for insurance balances
• Responsible to complete all error corrections and insurance updates to the facility/professional claim to resolve issues preventing payment
• Ability to obtain insurance eligibility and benefit information from payers via phone, RTE, or web for proper claims filing
• Review smart edits and payer rejections and perform all necessary rework for reimbursement of services
• Must possess the ability to work in different systems including claims eligibility, online payer claims system, as well as all AR management systems
• Escalating non-denial payer issues, including review of outstanding AR greater than 90 days, and sharing details with payers and management
• Work closely with multiple departments to obtain necessary information to resolve outstanding AR
• Update and verify insurance records as needed to correct outstanding accounts
• Responsible for ensuring claim has been received and is processing with payer within the timely filing period as defined by departmental goals and insurance guidelines
• Ability to present trends and issues to payers during monthly provider calls
• Gather information from payers to submit payment research requests when payment is not posted to an account
• Produce reports and data in Excel as needed
• Must have working knowledge of registration, payment posting, error correction and other billing functions
• Exhibit professionalism and good customer service skills
• Ability to maintain confidentiality and handle sensitive information
• Responsible for responding to emails within 24/48-hour turnaround time from receipt
• Responsible for utilization of time and management of work processes to ensure organizational and departmental expectations are met
• Other duties as assigned.

Requirements

• High School Diploma or equivalent
• 3+ years medical office or medical billing/collections experience in a hospital or centralized billing setting
• Must possess knowledge of CPT, HCPCS, and ICD-9/10 codes
• Must have a good working knowledge with insurance explanation of benefits (EOB) and comprehensive understanding of remittance and remark codes
• Be familiar with multiple payer requirements for claims processing
• Solid skills with Microsoft office with a focus on Excel and Word
• Good Communication Skills

Nice-to-haves

• Associates degree
• 4+ years' experience in a centralized billing setting
• Possess an in-depth working knowledge and experience with all types of insurance billing guidelines: Commercial, Medicare Part A and B, Medicaid, Managed Care plans etc.
• Experience with multiple specialty billing, collections, and denials