Job: Collection Specialist

Collection Specialist

Summary: Facilitates improvement in the overall, completeness, accuracy of concurrent coding for reimbursement purposes, and demonstrates successful appeal and audit responses to third-party payers concerning hospital clinical Case Management and bill claim denials. Serves as an educational resource for staff and physicians to reduce or eliminate denials.

Essential Duties and Responsibilities include:
• Maintains aging of receivables within established performance goals.
• Effectively contacts third party payers, patients, attorney offices, government agencies on aged and past due balances.
• Analyzes and resolves any possible claim denials from Explanation of Benefits.
• Submit re-bills, tracers and appeals; submit adjustments using appropriate reason code classifications. Identify bad debt accounts for adjustment and identify credits and refunds.
• Identifies trends/problems specific to payers in order to assure timely clean filing of claims.
• Keeps up to date on all current State and Federal Regulations and payer billing requirements.
• Contact insurance companies, patients, government agencies, other hospital departments, physician offices, attorney offices and other third party payers on aged and past due balances.
• Perform collection duties, rebilling research, correspondence, returned mail and problem solving of account billing errors.
• Verify billing information for electronic claims transmission and hard copy billing. Follow-up on accounts billed both electronically and manually.
• Review remittance advice forms to verify proper reimbursement and make adjustments as necessary.
• Ability to work effectively and establish rapport with clients, payor representatives, physicians, attorneys, co-workers.

Qualifications:
• Must have a proven track record of collection success from at least 2 years of hospital collection or registration experience.
• Must have some knowledge of CPT and ICD9 Coding.
• Must have understanding of Per diem and DRG reimbursement methodology.
• Excellent communication and organizational skills.
• Knowledge of CMS and AHCCCS coding and billing guidelines in an acute care setting.
• In depth knowledge of third party payer reimbursement policies.
• HMS/SSI experience preferred
• Experience with multiple systems, including but not limited to MS Word, Excell, Power Point.
• Data analysis skills are essential.

Education/Experience:
High School diploma required, college preferred