Billing Specialist - Medical Claim Denials

Job Description

Job Description

Description:

FloMed Infusion is an outpatient infusion clinic offering Medical Infusions and Injections in a relaxing ambulatory environment. For more specifics on what we do and who we are, please review our website

We are seeking an experienced Insurance Payor Collections Specialist. This role emphasizes precision in reviewing and evaluating insurance denials or returned claims. The candidate must effectively communicate with insurance companies and clients using a resolution-focused approach. Such communication should be guided by acquired knowledge, insurance carrier guidelines, company policies and procedures, as well as thorough research and collection efforts. Alongside claim follow-ups, the collection specialist will also be responsible for sending medical records and drafting appeals for denied claims to insurance companies.

• Deliver exceptional customer service to clients while maintaining strict adherence to HIPAA privacy and confidentiality standards.
• Precisely and comprehensively document all relevant information and follow-up actions in the electronic records system.
• Monitor and follow up on processed claims to ensure timely and accurate payment to the agency.
• Collaborate directly with insurance payers to confirm client eligibility and determine financial responsibility, including co-pays, deductibles, co-insurance, and out-of-pocket maximums.
• Pursue follow-up actions on insurance denials, including initiating appeals and requesting reconsiderations as appropriate.
• Support all billing-related tasks and responsibilities tied to both insurance and client invoicing, as needed.
• Investigate rejected insurance claims thoroughly and take appropriate action to reprocess or appeal denied or underpaid claims.
• Detect and analyze patterns in claim denials, escalating persistent payment delays or systemic issues to senior management.
• Communicate with insurance companies to resolve outstanding account balances and expedite claim resolution.

• Proven experience in medical collections or accounts payable/receivable is preferred.
• Strong understanding of financial concepts, accounting principles, and revenue cycle management.
• Excellent phone etiquette with the ability to communicate effectively with clients.
• Proficiency in financial software and accounting software for managing accounts.
• Knowledge of debits, credits, and account analysis is essential.
• Strong math skills for calculating payments, balances, and adjustments.
• Ability to work independently while managing multiple accounts efficiently.
• A commitment to maintaining confidentiality and compliance with industry regulations. Join our team as a Collection Agent where your skills will contribute significantly to our financial health while helping clients navigate their payment responsibilities.

Job Type: Full-time

Benefits:

401(k) matching

Dental insurance

Health insurance

Paid time off

Vision insurance

Experience:

collections: 1 year (Required)

Ability to Commute:

Delray Beach, FL 33446 (Required)