Healthcare Collections Specialist III

Job Description

Job Description

Evolve Treatment Centers offer cutting-edge intensive outpatient, partial hospitalization, and residential programs for teens ages 12 to 17 struggling with substance use and mental health disorders. We use evidence-based treatment modalities, including Dialectical Behavior Therapy (DBT), Cognitive Behavior Therapy (CBT), and Motivational Interviewing (MI), as well as several experiential therapies.

The Collections Specialist plays a key role in achieving company goals by managing outstanding accounts receivable, resolving payment issues, and providing effective, professional service. The ideal candidate demonstrates strong initiative, integrity, attention to detail, and excellent follow-up and communication skills, with a focus on maximizing collections and improving revenue.

The successful candidate will have experience managing healthcare accounts, following up on unpaid insurance claims, resolving billing discrepancies, and communicating with insurance providers and patients to ensure timely reimbursement. A solid understanding of healthcare billing, account reconciliation, and collections processes, along with a commitment to accuracy, professionalism, and regulatory compliance, is essential. Experience in behavioral health is a plus

The position requires a thorough knowledge of the healthcare industry and an assertive, effective strategy when working with insurance carriers to get claims paid.

Job responsibilities and duties include:

• Patient Advocate/Parent Follow Up – Daily
• Paid to Patient/Paid to Deductible/Private Pay – follow up weekly.
• Certified Mail package preparation– once/twice a week
• SCA (Single Case Agreements)
• Research and resolve complex claim denials, underpayments, and payment discrepancies
• Investigate and resolve complicated denials, underpayments, contractual adjustments, coordination-of-benefits issues, and reimbursement disputes
• Analyzes Explanation of Benefits and Remittance Advices and ensures claims processed according to members plans.
• Identifies denial reasons and follows appeal process to get claims paid.
• Performs high volume collection phone calls to insurance companies.
• Access payer online resources to expedite claims follow up and ensure claims are on file and processing.
• Prepare and pursue complex appeals, reconsiderations, and payer escalations within applicable filing deadlines
• Follow EOB protocol, retrieve documentation to ensure paid accounts are closed.
• Accesses billing software to analyze rejection reasons and communicate findings.
• Communicates billing/coding errors and completes resubmission request.
• Identifies and reports changes and trends in carrier guidelines and reimbursement patterns.
• Executes and delivers special projects from management and other duties as assigned.
• Corresponds with third party rate negotiation companies to expedite claim process.
• Accesses EMR, retrieves medical records and prepares for submission while following protocol and in a timely manner.
• Adheres to documentation protocol, notates accounts and reports appropriately.
• Organizes daily and weekly production/action reports in file share.
• Commits to providing excellent customer service while maintaining the highest degree of professionalism while working in a team environment to meet goals.
• Prepare, review, and send client statements
• Patient balance collections
• Understands and comply with all HIPAA rules and regulations.
• Office/Facilities and any other duties assigned.
• **Experience with KIPU and CollaborateMD is a plus!
• Working knowledge of healthcare billing processes and procedures

Requirements

• Experience working in Healthcare as Collections Specialist, especially Behavioral Health claims collection.
• 3-5 years High Volume corporate Collections experience
• Knowledge of Billing and Collections procedures
• Experience working with online payer resources.
• Excellent phone etiquette and oral communication skills
• Experience speaking with Payors.
• Experience speaking with families, parents etc. and collecting money.
• Accounts Receivable knowledge/experience
• Strong attention to detail, goal oriented
• Commitment to excellent customer service
• Ability to work efficiently within deadlines.
• Excellent written and verbal communication abilities
• Strong interpersonal skills and ability to work in a team environment.
• Ability to prioritize and manage multiple responsibilities.
• Adheres to all policies and procedures as outlined in the Employee Handbook
• Proficiency in using Microsoft Office products.

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