Follow Up & Collections - Billing Specialist IV - Non NSA

About PHI Health PHI Health is the leading air ambulance provider in the United States. With an unmatched safety record and the best aviation, medical and communication specialists in the field, we transport more than 22,000 patients each year from more than 80 bases across the country, while offering services and outreach education to local communities and leading healthcare systems. Job Summary Under the direction and supervision of the Team Operational Coordinator (TOC), the Follow‑Up & Collections III position performs all collection tasks. The role includes managing patient accounts from resubmission through final resolution, addressing denials, writing appeal letters, and ensuring account balances are correct based on payer contract terms. Responsibilities Acts as a patient advocate to obtain additional information and support for claims processing or to discuss outstanding patient balance with options available for balance resolution. Analyze adverse billing, collections, and payer trends and report/present to management to include suggested solutions. Assist with special projects related to payer issues or overall collections shortfalls. Contact insurances in an assertive, consistent, and knowledgeable manner to obtain timely payments, including escalation of issues to supervisors and/or grievance departments. Category and quantify payer payment issues for resolution and reporting to management. Maintain consistent customer focus in the face of adversity and change both internally and externally. Demonstrate understanding of payer fee schedules, enrollment requirements along with PHI payer and facility contracts. Draft correspondence to patients and payers including first‑level appeals for technical denials, and identify accounts to refer to Appeals Department for escalation. Handle patient calls in support of collections activities, including financial review for charity program, payment plans, negotiation of discounts and proper resolution of patient complaints. Maintain professional relationships and effectively communicate with first responders, facilities, PHI agencies, attorneys and patients. Organize and prioritize work to support production goals using online tools and required systems/software. Perform financial screening for payment in full offers, setting up payment plans and PHI's charity program in compliance with PHI's billing policies and procedures for appropriate next actions. Perform in‑depth account review such as skip tracing, correspondence research, secondary claims billing, payment review, contractual adjustments and modify insurances/demographic information in compliance with PHI's billing policies and procedures for appropriate next actions. Identify, collect and confirm insurance coverage, including obtaining prior authorization, third‑party liability and coordinator of benefits. Possess knowledge of HCPCS, CPT, ICD‑9, ICD‑10 codes, medical terminology and clinical documentation. Provide leadership and act as a resource for management to assist, train and provide support to the PFS Billing Staff. Research, evaluate and communicate to the team, payer‑specific billing policies, guidelines and statutory regulations for insurance and collection follow‑up. Respond, monitor and track claims and correspondence and prioritize work accordingly to maintain and meet production standards. Review and evaluate any patient account for appropriate handling, regardless of age, status or payer. Review and interpret explanation of benefits to determine contractual compliance, accuracy of payment received, true patient responsibility, status of denied or reduced service coverage and follow up appropriately. Take direction, coordinate projects and prioritize assignments individually and at departmental/team level. Understand billing requirements for all payers and participate in ensuring claims are accurate prior to submission; train staff on billing requirements for new and established payers. Understand insurance regulations and guidelines, including CMS guidelines, to effectively discuss outstanding claims with payers related to slow payments, underpayments, denials. Comply with Company HS&E policy and procedures and support company Safety Management Systems activities. Provide visible support of Destination Zero and other safety initiatives. Qualifications High school diploma (or GED equivalent); some college preferred. Previous experience in medical billing/collections with a progressive increase in complexity and responsibilities. Knowledge of general office procedures and office equipment. Proficiency in Microsoft Office Word, Excel and medical billing software. Prior experience with email and web usage. Ability to pass a pre‑placement drug test and background screen. Position designated Safety Sensitive for purposes of the Arizona Medical Marijuana Act. Schedule & Location Phoenix, AZ – 5 & 2 Compensation & Benefits Regular pay scale applies. Sign‑on bonus up to $7,500. (Other benefits not specified here.) EEO Statement PHI, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. #J-18808-Ljbffr Phi Health, LP