Collection Specialist

JOB SUMMARY:

The Collections Specialist supports the effective management of the revenue cycle process and ensures the accurate and timely collection of sales to third party payers (including Medicare, Medicaid, Private Insurance, and other funding sources). The Specialist works with insurance companies, clients, and customers to resolve collection issues and reconciles accounts.

KEY RESPONSIBILITIES:

After an account is billed, the account becomes the Collector's responsibility. The Collector is responsible for:

• Verification that a claim is on file

• Follow up with the payer due to lack of payment

• Investigation of denials

• Coordination with the billers to address billing issues

• Coordination with the funding consultants to address documentation questions

• Preparation of correspondence, such as appeals, to fight for the payment of accounts, request different denial codes, etc.

• Review of posted payments for accuracy and investigate differences

Other Responsibilities:

• Manage assigned accounts and ensure the timeliness and accuracy of billing, collections, and payment activity

• Document in the system all verbal and written communication relative to collection actions and expected outcomes of overdue accounts.

• Follow up every 30 days with insurance companies, clients, SPLs, and vendors to ensure the payment of accounts

• Alert the Manager of Collections of potential payment issues

• Recommend adjustments/write-offs to the Manager of Collections and receive approval prior to reconciling accounts

• Investigate refund requests related to accounts and complete refund paperwork for accounts that need to be refunded

• Meet the expectations and goals for productivity and cash targets as set forth by management

• Stay abreast of state, federal, and third-party funding regulations for assigned accounts ensuring billing and payment practices comply with third party payer requirements

• Perform various other tasks as assigned

MINIMUM QUALIFICATIONS:

EDUCATION / EXPERIENCE REQUIREMENTS:

• High School Diploma

• 2 or more years of computer, accounting, collections, and high-volume medical billing and/or insurance claims processing experience

• Knowledge of payment posting process in regard to contractual adjustments and refunds preferred

• Knowledge of medical insurance claims procedures and documentation preferred

COMMUNICATION SKILLS:

• Strong customer service and interpersonal skills

• Oral and written communication skills

• Teaming skills

COMPUTER OR TECHNICAL SKILLS:

• Proficient in M.S. Office Word, Excel, and Outlook

• Able to research claim information via the internet

• Basic data and word processing skills

OTHER SKILLS REQUIREMENTS:

• Apply independent judgment and manage confidential information

• Ability to gather data and summarize information

• Time management and good organizational skills

• Excellent problem solving skills

• Record management

PHYSICAL REQUIREMENTS:

• See, hear, and speak

• Kneel, stand, and reach

• Ability to lift and/or move up to 10 pounds

WORK ENVIRONMENT REQUIREMENTS:

• Ability to work at a desk for prolonged periods of time

• Ability to work with interruptions in a fast-paced environment

• Ability to travel to the Pittsburgh office for team activities/ trainings (approx. 4 times per year)