We are looking for a motivated performer to join our Business Office team as a Collections Specialist, with an extensive knowledge of claims reimbursement and collection efforts for Managed Care, Medicare, Medicaid, Workers Comp, Commercial plans, etc. We are looking for a top performer with an extensive knowledge of billing, collections, and reimbursement of claims processing.

This is a fast-paced environment committed to producing the highest quality work for our surgery center. An ideal candidate will be personable and courteous. We are looking for a competent Collection Specialist to contact clients and collect outstanding payments. You will strike a balance between maintaining trustful relationships and ensuring timely payments. Our Collection Specialist should exhibit professionalism and trustworthiness. You should have excellent communication and negotiation skills, as well as an ability to work independently and interdependently with other business office staff.

Under the direction of the Business Office Manager, the Collections Specialist is responsible for follow up on delinquent surgery center claims), working an expected number of claims per day. Majority of claims will have been submitted to various insurance carriers electronically. Knowledge of how to interpret a managed care contract, Medicare and Medicaid and Workers Compensation claims is a must. You will be given tools to calculate allowable and required to determine appropriateness of reimbursement and appeal claims as necessary. Extensive contact with insurance carriers of all types, as well as communication with patients regarding out-of-pocket amounts is required. Identification of accounts that have been either under or over paid, issuing credit balance information either to the insurance carrier or the patient. All of these practices done in a professional and communicative manner, per policies and procedures, guidelines, internal control measures and established goals. . Candidate must be a team player, and have ability to communicate well with direct reports, patients, customers, insurance carriers, etc. Ability to manage accounts worked independently, and in a productive manner. Must project a professional demeanor and appearance while maintaining the confidentiality of the surgery center and patients. Works well in stressful environment and in situations that demand patience.

Projects a professional demeanor and appearance while maintaining the confidentiality of administration, patients, physicians and employees. Works under stress and in situations that demand patience and tact while providing impeccable service.

BENEFITS Our competitive salary and benefits package includes medical and dental insurance, 401(k), paid time off and life insurance.

Required Skills Required Experience

REQUIRED EXPERIENCE:

• 3-4 years previous collections experience, with emphasis on healthcare insurance collections of all types.
• 3-4 years previous HOSPITAL collections experience in DDE system and Ability Ease. 2-3 Years previous HOSPITAL collections experience in Worker’s Comp
• Function as a subject matter expert (SME) for Medicare and Workers Comp request
• Function as a subject matter expert (SME) for the following appeals:
  • Clinical
  • Medical Necessity
  • Authorization
  • Non-Covered
  • Underpayments
• Proficient with Microsoft Office products
• Prefer previous experience with Electronic Health Record system but will train.
• Prefer previous experience working with Cerner/AdvantX/Meditech. (Patient Accounting System)
• High School Diploma or equivalency.
• Medical terminology.
• Ability to work independently.
• Excellent communication skills and interpersonal skills.
• Skilled in time management and prioritization of emergent situations.
• Good customer service skills, always demonstrates professionalism.
• Comfortable utilizing critical thinking skills.