Medical Collection Specialist

Job Responsibilities

• Review (AR) by payer daily to maintain or achieve reimbursement goals and days in AR.
• Prepare timely appeals to overturn medical necessity, and various denials.
• Provide regular feedback to management based on payer research and behavior trends.
• Weekly feedback on payer/facility adjudication concerns.
• Improve reimbursement outcomes and resolve outstanding claims inventory.
• Identify the root cause of the non-payment and resolve the claim denial issue, including coding and billing errors, documentation issues and compliance discrepancies.
• Maintain high productivity and quality of work.
• Achieve a minimum score of 95% on all Quality Assurance audits.
• Develop and execute effective appeals strategies to overturn denied claims.
• Prepare and submit detailed and well-documented appeals to insurance companies within specified deadlines.
• Possess knowledge of medical coding specific to professional emergency room and hospital medicine services.
• Collaborate with coding specialists to address and rectify coding-related denial issues.
• Stay current on insurance policies, guidelines, and industry changes affecting emergency room and hospital medicine services.
• Collaborate with the medical billing team to address root causes of denials and implement preventive measures.
• Provide training to billing staff on denial prevention and resolution.
• Maintain production standards.

Requirements

• High School or Equivalent Required: Proven experience in denial management, specifically in professional emergency room and hospital medicine service.
• 2+ years of experience in Medical Insurance Denials Management.
• 2+ years of experience in customer service and patient billing within the medical industry.
• Experience reading Explanation of Benefits (EOB’s) for Government, Commercial, PPO, HMO/IPA, and Workers’ Compensation payers.
• Ability to review and validate credits to be refunded and validate recoupment demands.
• Intermediate ability to assess and verify patient liability, coinsurance, deductibles, and denial codes.
• Intermediate knowledge of MS Office.
• Knowledge of ICD-9, ICD-10, CPT, HCPCS coding, and general claims processing practices.
• 10-key by touch, Proficient in MS Excel, and Word.
• Previous patient medical billing, OnBase, Centricity, and Way Star, Payor Portals experience a plus.

Education (Required And/or Preferred)

• High School or Equivalent Required.

Primary Location

Dallas, TX Office (On Site 4 days a week / 1 day remote)

Pay Range

18.00 - 26.00 USD per hour

Benefits

We offer a comprehensive benefits package designed to support your health, financial well-being, and work-life balance, including medical dental, vision insurance, a 401(k) plan with a company match, paid time off and holidays, professional development support, and employee wellness resources. Visit our website for further information. https://myscpbenefits.com/