Experienced BCBS Insurance Collections Specialist

AIS Healthcare is the leading provider of Targeted Drug Delivery (TDD) and Infusion Care. With our diverse culture, and our values around Innovation, Stewardship, and Unity, we are committed to Advancing Quality and Improving Lives. We are dedicated to doing more for our patients by providing quality products and services that enhance the entire care experience.

About the role

This full-time, 100% work-from-home Accounts Receivable Collection role is responsible for collection processes for TDD services, including contract analysis, reimbursement, denial management, appeals, and resolving billing-related issues with insurance companies or other responsible parties for services rendered.

Responsibilities

• Recognize patients’ rights and responsibilities; support and respect patient privacy and confidentiality.
• Follow up on invoices to ensure prompt and timely payment; escalate issues as necessary.
• Evaluate payments and denials for correctness; ensure proper application.
• Identify bad debt write-offs and A/R adjustments; initiate write-offs and adjustments in accordance with policies and procedures.
• Identify overpayments and/or duplicate payments; investigate and resolve accordingly.
• Process refund requests in accordance with policies and procedures.
• Maintain contact with other departments to obtain patient or insurance information needed for claim payment.
• Understand and comply with all procedures within regulatory mandates, including Federal, State, and payer regulations.
• Troubleshoot payment discrepancies via phone calls; document details consistently (e.g., phone number, person spoken to, call details).
• Maximize claim reimbursement by identifying areas for improvement.
• Resolve denial issues within 5 days of receipt.
• Maintain strictest confidentiality; adhere to all HIPAA guidelines and regulations.
• Maintain knowledge of NDC (National Drug Code) numbers, metric quantities, infusion supplies, insurance plans, medical terminology, billing procedures, government regulations, and medical codes.
• Share knowledge with team members; work collaboratively in a positive, respectful, and considerate manner.
• Perform other job-related duties as assigned.

Requirements

• High school diploma or GED equivalent.
• 3–5 years of healthcare industry experience.
• 3–5 years of medical billing and collections experience, specifically with Blue Cross Blue Shield.
• Home Infusion or Intrathecal Pain Management experience preferred.

Qualifications

• Ability to recognize, evaluate, and exercise good judgment in solving complex situations in accordance with laws and regulations.
• Excellent verbal and written communication and relationship-building skills; ability to prioritize, negotiate, and work with internal and external stakeholders.
• Strong work ethic with personal qualities of integrity and credibility.
• Self-directed, detail-oriented, conscientious, organized, and able to follow through.
• Ability to manage problems involving multiple variables within the scope of the position.
• Tolerance for frequent interruptions and distractions from staff and support teams.
• Proficient in Microsoft Office (Outlook, Word, Excel).

Benefits

• Health, vision, and dental insurance.
• Long-term disability and life insurance.
• Vacation package.
• 401K plan with a generous employer match.