Healthcare Collections Specialist - RCM

Collection Specialist

The collection specialist will focus primarily on resolving insurance claims from Medicare, Medicaid, and commercial plans that are underpaid or denied. They will use their payor knowledge and critical thinking skills to correctly identify denial root causes and effectively take action to get claims reprocessed and paid. The collection specialist must have a good grasp on professional billing in order to help vet the accuracy of claims billed and identify any billing or set up issues that may cause unclean claims. The collection specialists must have a strong background in claims reconsiderations and appeals.

Responsibilities:

• Responsible for follow-up on outstanding claims with insurance companies through portals and phone calls.
• Research and resolve incorrectly processed claims.
• Determine root causes and establish trends across payors and/or sites.
• Utilize reconsiderations and appeals to accurately fight denied or underpaid claims.
• Understand other aspects of revenue cycle management (such as benefits, authorizations, billing) to identify any front-end errors and take steps to correct as needed.
• Perform core tasks and claim follow-up efficiently; meet production goals, quality standards, and team goals and partner with leadership to deliver overall strong results.
• Respond to all insurance and claim related correspondence timely.
• Perform other duties as assigned by supervisor.

Minimum Qualifications:

• Knowledge of CPT, HCPCS, and ICD-10 coding
• Expertise in health insurance claim denials
• Understanding payor requirements
• Previous medical billing and claims collection experience
• Ability to evaluate options and to make efficient decisions
• Strong written and verbal communication
• Ability to read an EOB and understand denial reason codes
• Infusion background a plus
• Exhibit overall behavior and actions that demonstrate willingness to learn, be coached, and take accountability for self-improvement and growth; be a collaborative team player.