Collections Specialist

Houston, TX 77027

Employment Type: Contract Job Category: Medical Billing Job Number: 57776 Pay Rate: 20

Job Description


This position is responsible for the following:

  • Effectively review and research claims denials and contact payers to verify detailed denial reasons when necessary.
  • Contact patients to obtain accurate insurance information.
  • Phone appeals & reconsiderations for denied or rejected claims.
  • Must be able to identify and communicate denial/rejection trends to management.
  • Follow up on all claims from billing through final resolution.
  • Correct and identify billing errors and resubmit claims to insurance carriers
  • Review insurance EOB and initiate appeals as necessary
  • Respond to Payer s request for additional information/documentation Posting account adjustments as a result of written communication from third parties (i.e., certain contractual adjustments)
  • Answer incoming calls and assist insurance carriers with their requests Communicate patient responsibility with the patient
  • Collect on patient balances and/or establish a payment plan
  • Review weekly schedules for patients with upcoming appointments, contact patients and communicate to front desk arrangements made to collect balances
  • Return mail (patient statements) and contact the patient to obtain the correct billing address and/or payment.
  • Navigate and research insurance policies & benefits for policy exclusions for patients.
  • Navigate and research payer medical reimbursement policies and exclusions.
  • Complete request for reconsideration forms while following payer requirements.
  • Prepare documentation and file appeals and reconsiderations as appropriate.
  • Review and work on all daily correspondence received from patients and payers.
  • Must be aware of the timely filing guidelines associated with reconsiderations and appeals for assigned payers.
  • Review accounts for accuracy (payments and adjustments)
  • Knowledgeable of medical EOBs, patient deductibles and co-pays, and insurance or third-party correspondence.
  • Experience working with payer websites.
  • Experience in working-aged AR
  • EDI transactions/troubleshooting.
  • Other assigned duties.

Qualifications and Requirements

  • High School Diploma or GED is required.
  • 2-5 years of medical billing, collections, and payment posting experience. Urology experience preferred.
  • Certified Professional Coder (preferred but not required).

Skills, Knowledge, and Abilities

  • Knowledge of CPT Coding, ICD10, and use of appropriate modifiers.
  • Experience working on appeals and composing appeal letters.
  • Knowledge of bundling and global periods.
  • Experience working in Microsoft Word & Excel, Outlook, Teams, & Athena is a PLUS!
  • Experience working in medical collections, both insurance and patient
  • Knowledge of insurance plans, claims, and billing processes.
  • Must have a working knowledge and proficiency in medical terminology.
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