Specialist-Collections II - Spartanburg Regional Healthcare System

Position Summary

The Collections Specialist is responsible for managing and collecting on accounts receivables for all insurance carrier plan services billed through the hospital/physician billing systems. This position is responsible for timely and accurate claims follow up and payer corrections to meet and exceed our departmental cash collection and AR goals.

Minimum Requirements

Education

• Highs School Diploma or equivalent

Experience

• 3+ years medical office or medical billing/collections experience in a hospital or centralized billing setting.
• Must possess knowledge of CPT, HCPCS, and ICD-9/10 codes.
• Must have a good working knowledge with insurance explanation of benefits (EOB) and comprehensive understanding of remittance and remark codes.
• Be familiar with multiple payer requirements for claims processing
• Solid skills with Microsoft office with a focus on Excel and Word.
• Good Communication Skills

License/Registration/Certifications

• N/A

Preferred Requirements

Preferred Education

• Associates degree

Preferred Experience

• 4+ years’ experience in a centralized billing setting.
• Possess an in-depth working knowledge and experience with all types of insurance billing guidelines: Commercial, Medicare Part A and B, Medicaid, Managed Care plans etc.
• Experience with multiple specialty billing, collections, and denials

Preferred License/Registration/Certifications

• N/A

Core Job Responsibilities

• Collections of all outstanding claims by direct payer contact, utilization of payer websites, and EDI/Claims system
• Research and resolve all payments issues/errors for insurance balances
• Responsible to complete all error corrections and insurance updates to the facility/professional claim to resolve issues preventing payment
• Ability to obtain insurance eligibility and benefit information from payers via phone, RTE, or web for proper claims filing
• Review smart edits and payer rejections and perform all necessary rework for reimbursement of services
• Must possess the ability to work in different systems including claims eligibility, online payer claims system, as well as all AR management systems
• Escalating non-denial payer issues, including review of outstanding AR greater than 90 days, and sharing details with payers and management
• Work closely with multiple departments to obtain necessary information to resolve outstanding AR
• Update and verify insurance records as needed to correct outstanding accounts
• Responsible for ensuring claim has been received and is processing with payer within the timely filing period as defined by departmental goals and insurance guidelines
• Ability to present trends and issues to payers during monthly provider calls
• Gather information from payers to submit payment research requests when payment is not posted to an account
• Produce reports and data in Excel as needed
• Must have working knowledge of registration, payment posting, error correction and other billing functions
• Exhibit professionalism and good customer service skills
• Ability to maintain confidentiality and handle sensitive information
• Responsible for responding to emails within 24/48-hour turnaround time from receipt
• Responsible for utilization of time and management of work processes to ensure organizational and departmental expectations are met
• Other duties as assigned.

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