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Role Description

Reporting to the Client Operations Manager, the Revenue Cycle Specialist - Collector must have a strong knowledge of medical collections, accounts receivables, insurance billing and verification, denial processing, appeal submission and EOB review. This position is responsible to resolve outstanding surgical claims resulting in maximum reimbursement.

• Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers including self-pay to obtain maximum reimbursement.
• Manage daily work queue to prioritize high dollar claim balances.
• Review & work incoming insurance and patient correspondence including refund requests.
• Send appeals when appropriate or provide the requested medical documentation.
• Ability to review medical documentation to justify medical necessity.
• Review patient balances to ensure accuracy and follow up with patients to obtain payments.
• Take incoming patient phone calls to resolve inquiries, billing issues, or outstanding balances.
• Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents.
• Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD’s) for claim resolution.
• Negotiate payment amounts for procedures with Third Party Administrators for out of network providers.
• Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.

Qualifications

• Strong knowledge of medical collections.
• Experience with accounts receivables.
• Familiarity with insurance billing and verification.
• Understanding of denial processing and appeal submission.
• Ability to review EOBs.

Requirements

• Experience in resolving outstanding surgical claims.
• Ability to prioritize high dollar claim balances.
• Strong communication skills for patient interactions.
• Knowledge of Medicare and state Medicaid.
• Negotiation skills with Third Party Administrators.

Benefits

• Competitive salary.
• Health insurance options.
• Retirement plan contributions.
• Opportunities for professional development.