Revenue Cycle Collections Specialist

Seeking Collections Specialist with extensive experience in overturning denials. The candidate should preferably have direct experience working in a medical billing company, though not required.

The Collections Specialist will perform insurance collections for various regional and national payers, including Federal, State, Third Party (HMO, PPO, IPA, TPA Indemnity) and patient billing. The Collections Specialist will review accounts for billing accuracy in order to maximize reimbursement. The Collections Specialist will follow-up on claims status, appeal, and re-bill or forward claims for recalculation and/or adjudication as necessary. This person must possess detail knowledge of all medical benefit levels and a have a thorough understanding of Federal, State, and PPO, HMO, and Indemnity Plans structure.

Responsibilities

• Data entry, correct insurance assignment to patient accounts.
• Review/update demographics and patient information for accuracy.
• Investigate all denied services to determine the reason for the service denial, appeal, if appropriate. Identify, report root causes associated with denials.
• Timely, effective processing of assigned appeals including development, submission, tracking, reporting and evaluation of appeal outcomes (i.e., next steps, improved outcomes).
• Processing, validation of payer requests and processed claims via correspondence, remittance advice and EOBs (i.e., identification of payment discrepancies, inappropriate requests).
• Working knowledge of appropriate coding systems; CPT, ICD-10 and HCPCS, coverage; LCD/NCD and reimbursement associated with such codes.

Qualifications
To perform this position successfully, an individual must demonstrate regular, predictable attendance and be able to perform essential duties satisfactorily. The requirements listed below are representative of the knowledge and skill required. The individual must be able to successfully pass background checks.

Experience Needed
5+ years of medical collection experience is required.

Physical Requirements
To accomplish the essential functions of the position, one must be physically able to operate or work with computers, calculators, reference books, computer software applications, phones, and other standard office equipment.

Compensation
Competitive salary based on experience.

Position Location
Boca Raton, Florida or virtual/remote.

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