Medical Collections Specialist

Medical Collections Specialist

The Medical Collections Specialist is responsible for the full lifecycle of account balances, including the collection of outstanding insurance and patient-pay debits, and the timely resolution of credit balances. This role ensures financial accuracy by researching rejections, managing payment arrangements, and processing refunds or adjustments for overpayments across all payer types.

Duties and Responsibilities

• Comprehensive A/R Management: Perform all aspects of account follow-up on insurance claims, self-pay accounts, and accounts with outstanding patient liability.
• Credit Balance Resolution: Analyze and research credit balances for both insurance payers and patients to determine the root cause of overpayment and initiate necessary refunds or adjustments.
• Patient Collections: Collect delinquent accounts by establishing formal payment arrangements with patients and monitoring for payment lapses.
• Insurance Follow-Up: Submit written appeals to overcome denials and conduct regular follow-up with payers to facilitate uninterrupted cash flow.
• Claim Processing: Assist in processing insurance claims, including working through clearinghouse denials and researching rejections.
• Communication: Answer inquiries from patients, customers, and insurance payers regarding account balances, credits, and payment statuses.
• Compliance: Adhere to all practice policies related to HIPAA and Medicare Compliance, as well as guidelines for refund processing.
• Reporting: Provide consistent feedback to management regarding account issues, delinquency trends, and credit resolution progress.

Supervisory responsibilities are not applicable for this position.

Qualifications

• High school diploma or general education degree (GED), or one to three months related experience and/or training, or equivalent combination of education and experience.
• Knowledge of home infusion billing/coding and CareTend software preferred
• Computer skills required: Microsoft Office Suite, Google Suite, spreadsheets, and Email
• Perform follow-up activities in a timely manner on all accounts to ensure prompt payments.
• Minimum (2) years of experience in a medical office setting.
• Knowledge of Medicare, Medicaid, and Commercial payer collections.

Competencies

• Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.
• Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.
• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.

Physical Demands and Work Environment

• Continually required to stand, walk, sit, talk, or hear.
• Continually required to utilize hand and finger dexterity
• Continually utilize visual acuity to operate equipment, read technical information, and/or use a keyboard
• Occasionally required to lift/push/carry items less than 30 pounds

The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities, or physical requirements. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. We reserve the right to revise job duties. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.