Medical Collections Representative

Summary: The Medical Collections Representative is responsible for ensuring timely and accurate payment of healthcare claims. This includes resolving claims denials, processing payments, working refunds, patient collections, adjusting and monitoring accounts receivables with the goal of bringing the account to a zero balance.

Schedule: Monday-Friday 8a-5pm


Background check will be performed with an offer of employment.

*FOR INTERNAL CANDIDATES - SEE BELOW

Responsibilities:

1. Follow up on outstanding claims and resolve claim denials.
2. Patient Collections on unpaid balances to include establishing payment plans and Payment Assurance.
3. A/R Projects as assigned.
4. Process payments and adjustments.
5. Prepare patient refunds.
6. Communicate with insurance companies and patients.
7. Review and maintain AR within pre-set policies and goals.
8. Update patient demographics including new insurances as needed.
9. Answer patient inquiries.
10. Identify and resolve patient billing complaints and questions.
11. Prepare, review and send patient statements weekly.
12. Maintain strict confidentiality, adhere to HIPAA guidelines and regulations.
13. Update the patient account record to identify actions taken on the account in a timely manner.
14. Other duties as assigned.

Requirements:

1. Able to effectively and compassionately communicate with patients and clients.
2. Knowledge of medical billing/collection practices and timely filing guidelines.
3. Possesses an understanding of EOB's including Remittance Advice Remark (RARC) and Claim Adjustment Reason Codes (CARC).
4. Ability to function on multiple practice management programs, as well as other business office machines.
5. Knowledge of basic medical coding including CPT and ICD-10-CM coding guidelines.
6. Ability to work with patients, billing/coding and clinical staff.
7. Ability to work independently and prioritize projects.
8. Must be well-organized and detail oriented.

Experience: Must have 1 year experience in collections or medical billing field.

Education: High School Diploma or equivalent.

Mental and Physical Requirements: Must possess physical and mental abilities to perform the tasks normally that are mostly sedentary with occasional standing, walking, reaching. Daily and repetitive data entry may cause nerve problems unless ergonomic techniques are used. Periodic stress occurs from handling many calls and dealing with patient and provider requests.

Mental and Physical Requirements: Varied activities including standing, walking, reaching, bending and lifting. Must be able to use a variety of office equipment. May require working under stressful conditions. Must be able to lift 20 pounds.


Conditions: Normal office setting that requires the ability to work under pressure and with a diverse population, including staff, physicians, clients, patients, insurance companies, labs, hospitals and other members of the public on a regular basis.

*Make sure to submit transfer form to supervisor prior to applying to any opening of interest. To be considered for the opening - employee apply in addition to completing the transfer form.