Medical Collections Specialist

Job Type: Full-Time

JOB SUMMARY:

Performs consistent and timely follow-up on assigned receivable. Identifies trends in A/R and addresses issues promptly. Understands payer contracts. Takes prompt action on denials and underpayments. Requests adjustments as appropriate. Provides customer service.

 

QUALIFICATIONS:

  • High School graduate required
  • Four years of medical facility or medical business office experience required
  • UB Billing and Account Follow Up required
  • Experience in customer relations required
  • Experience in third party payer requirements required
  • Training/experience in business office activities preferred
  • Requires frequent and constant judgment for timely response to patient questions and concerns.

RESPONSIBILITIES:

  • Performs systematic, consistent, and timely follow-up. Takes action to progress the account to resolution. Insurance balances performs first follow-up within 20-30 days from date of service. Performs subsequent follow-up at least every 14 days until balance is paid.
  • Requests adjustments or refunds as applicable.
  • Identifies trends/issues within assigned receivable. Uses applicable status mnemonic. Reports status of A/R s requested. Works with appropriate payers, vendors, partners, Business Office Manager, hospital staff, and patients to resolve issues. Utilizes all available resources.
  • Promptly notifies Revenue Cycle Director and Director of Case Management of payer, system, coding, or other issues impacting billing or collections. Escalates problems to Provider Representative in a timely manner. Follows payer protocol.
  • Maintains knowledge of payer contract and requirements. Utilizes all calculators and contracts effectively to calculate correct allowable. Understand which calculator to use for each calculation.
  • Calculates patient responsibility. Explains in and out-of-network benefits to patients. Establishes payment arrangements within departmental guidelines. Documents accounts clearly in EMR.
  • Takes action on denied/returned/underpaid claims within 2 days of payment posting. Performs necessary research to investigate and takes appropriate action- rebill, reconsideration, refer case for clinical appeal. Requests adjustments when denials are correct.
  • Maintains current information on claims adjudication and payment policies on all encountered third party payers and governmental intermediaries.
  • Knows the verification and precert process. Performs verification/precert as needed, documents in Medi-tech, and makes appropriate notification to patient regarding liability. Files paperwork promptly with HIM for scanning into Medi-tech.
  • Assists all customers with questions and provides information in a professional and helpful manner and/or refers the patient to the proper person or vendor to assist him.
  • Maintains and protects each patient's right to confidentiality. Follows HIPAA regulations.
  • Participates in training/cross-training as directed.
  • Completes other duties as assigned.

Job Type: Full-time

Required education:

  • High school or equivalent
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North Metro Medical Center

1400 Braden Sreet
Jacksonville, AR 72076

Main Phone: 501-985-7000
24 Hour Phone: 501-517-3869

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