Medical Collections Specialist

Role Summary Performs a variety of AR activities and related tasks in order to recognize the maximum reimbursement from each claim. This position will be responsible for navigating the electronic medical record (EMR) and billing systems to obtain/produce and transmit the records required by the applicable insurance carrier or third party. Demonstrates understanding of explanation of benefits (EOBs) and ability to digest and respond appropriately to denials and correspondence. Clear and concise notation/documentation is paramount to success in the role. Responsibilities Understand and comply with all governmental, regulatory, company billing/AR and compliance regulations/policies assigned by payers. Analyze EOBs and construct responses to insurance carriers based on claim adjudication. Follow up with payers and other appropriate parties to collect open balances in a timely manner and to ensure compliance with payer guidelines. Identify and report payer issues regarding rejection trends, denial trends, or change in payments. Communicate specific payer information to appropriate parties/departments. Address denials and zero payments to identify and provide any requested documentation required to process the claim or refer to billing for claim corrections. Follow up and complete tasks on pending accounts in a timely manner until account is settled. Use of office equipment and software applications to facilitate finalization of claim. #J-18808-Ljbffr