Medical Collections Specialist

Role Summary

Performs a variety of AR activities and related tasks in order to recognize the maximum reimbursement from each claim. Navigates the EMR and billing systems to obtain/produce and transmit the records required by the applicable insurance carrier or third party. Demonstrates understanding of EOBs and ability to digest and respond appropriately to denials and correspondence.

Responsibilities

• Understand and comply with all governmental, regulatory, company billing/AR and compliance regulations/policies assigned by payers.
• Analyze EOBs and construct responses to insurance carriers based on claim adjudication.
• Follow up with payers and other appropriate parties to collect open balances in a timely manner and to ensure compliance with payer guidelines.
• Identify and report payer issues regarding rejection trends, denial trends, or changes in payments.
• Communicate specific payer information to appropriate parties/departments.
• Address denials and zero payments to identify and provide any requested documentation required to process the claim or refer to billing for claim corrections.
• Follow up and complete tasks on pending accounts in a timely manner until account is settled.
• Use of office equipment and software applications to facilitate finalization of claim.

Qualifications

N/A

Skills

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Benefits

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Pay

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Schedule

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