Role Description
The Collection Specialist supports the effective management of the revenue cycle process and ensures the accurate and timely collection of sales to third party payers (including Medicare, Medicaid, Private Insurance, and other funding sources).
- Manage assigned accounts and ensure the timeliness and accuracy of billing, collections, and payment activity
- Verification that a claim is on file
- Follow up with the payer due to lack of payment
- Investigation of denials
- Coordination with the billers to address billing issues
- Coordination with the funding consultants to address documentation questions
- Preparation of correspondence, such as appeals, to fight for the payment of accounts, request different denial codes, etc.
- Review of posted payments for accuracy and investigate differences
- Document in the system all verbal and written communication relative to collection actions and expected outcomes of overdue accounts
- Follow up every 30 days with insurance companies, clients, SPLs, and vendors to ensure the payment of accounts
- Alert the Manager of Collections of potential payment issues
- Recommend adjustments/write-offs to the Manager of Collections and receive approval prior to reconciling accounts
- Investigate refund requests related to accounts and complete refund paperwork for accounts that need to be refunded
- Meet the expectations and goals for productivity and cash targets as set forth by management
- Stay abreast of state, federal, and third-party funding regulations for assigned accounts ensuring billing and payment practices comply with third party payer requirements
- Perform various other tasks as assigned
Qualifications
- High School Diploma
- 2 or more years of computer, accounting, collections, and high-volume medical billing and/or insurance claims processing experience
- Knowledge of payment posting process in regard to contractual adjustments and refunds preferred
- Knowledge of medical insurance claims procedures and documentation preferred
Requirements
- Strong customer service and interpersonal skills
- Oral and written communication skills
- Proficient in M.S. Office Word, Excel, and Outlook
- Able to research claim information via the internet
- Basic data and word processing skills
- Apply independent judgment and manage confidential information
- Ability to gather data and summarize information
- Time management and good organizational skills
- Excellent problem solving skills
- Record management
Work Environment Requirements
- Ability to work at a desk for prolonged periods of time
- Ability to work with interruptions in a fast-paced environment
- Ability to travel to the Pittsburgh office for team activities/trainings (approx. 4 times per year)
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