Collection Specialist (On-site)

General Summary: This position is primarily responsible for performing a variety of duties with the goal of maximizing cash flow and minimizing outstanding receivables and interacting with patients and insurances to secure payment on patient accounts

Supervisory Responsibilities: This position has no supervisor responsibilities.

General Requirements: All duties performed will be done accurately and in a timely manner.

1. Collects balance owing from third party payers in accordance with state and federal laws governing collection practices.
2. Processes correspondence and denials from the Insurance Carrier.
3. Posts contractual adjustments as needed.
4. Posts write off adjustments after approval from the Director - Business Office.
5. Processes payments by credit card.
6. Answers calls and correspondence received by patients.
7. Requests additional information within the organization such as medical records, explanation of benefits, etc. to appeal claims that have been denied.
8. Responsible for Work Aged Accounts Receivable Report.
9. Processes refunds as needed.
10. Verifies insurance eligibility when needed.
11. Review commercial contract reimbursement guidelines for proper claim adjudication.
12. Ensure daily productivity standards are met in accordance to documented procedures.
13. Exercise tact and courtesy when dealing with patients, visitors, physicians and co-workers.
14. Able to work efficiently under pressure.
15. Maintain strict confidentiality.
16. Other duties as assigned.

Essential Job Responsibilities:

1. Will be reviewing accounts for accuracy and reviewing future appointment to collect balances owed
2. Taking and making outbound calls to patients owing balances
3. Collects balance owing from third party payers in accordance with state and federal laws governing collection practices.
4. Processes correspondence and denials from the Insurance Carrier.
5. Posts contractual adjustments as needed.
6. Posts write off adjustments after approval from the Director - Business Office.
7. Processes payments by credit card.
8. Answers calls and correspondence received by patients.
9. Requests additional information within the organization such as medical records, explanation of benefits, etc. to appeal claims that have been denied.
10. Responsible for Work Aged Accounts Receivable Report.
11. Processes refunds as needed.
12. Verifies insurance eligibility when needed.
13. Review commercial contract reimbursement guidelines for proper claim adjudication.
14. Ensure daily productivity standards are met in accordance to documented procedures.
15. Exercise tact and courtesy when dealing with patients, visitors, physicians and co-workers.
16. Able to work efficiently under pressure.
17. Maintain strict confidentiality.
18. Other duties as assigned.

Education and Training: Minimum high school education or equivalent.


Experience: Minimum of 2 years' experience in any government and/or commercial insurance billing, collections payment and reimbursement verification and/or refunds. Minimum of six months of medical billing in a general medical office, Knowledge of medical terminology. Knowledge of insurance industry. Knowledge of insurance contracts and reimbursement rates. Knowledge of Medicare's Correct Coding Initiatives preferred. Knowledge of grammar, spelling, and punctuation to type correspondence. Must have knowledge of ICD-9 and CPT-4 coding, medical terminology, 10 key touch and computer skills. Bilingual ability in English/Spanish preferred. Certified Medical Insurance Specialist Preferred.

Other Requirements: Knowledge of Microsoft Office Applications strongly preferred. Word Processing software, database software, spreadsheet, and Internet software

Work Environment: Depending upon the area assigned, may be 100% clinical setting or office setting in a clinical environment. Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations, and other conditions common to a clinic environment.

Mental / Physical Requirements: Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting to 40 lbs. Close vision and ability to adjust focus.

Additional Information: Gonzaba Medical Group is seeking team members who contribute as A-Players, demonstrate a strong work ethic, are committed to our culture and core values.

Other Duties As Assigned: The above job description is not intended to be an all-inclusive list of duties and standards of the position. Team members will follow any other instructions, and perform any other related duties, as assigned by their supervisor. Responsibilities, knowledge, skills, abilities, and work environments may change as needs evolve.