Job Description

Medical Insurance Collections Specialist

Administrative Office TX · Revenue Cycle Management
Irving, TX
Finance/Insurance/Reimbursement
Full Time, Days
Weekly Schedule: Monday - Friday Start time varies between 6:30am and 9:30am must work eight hours daily.
Bilingual: Preferred
Bilingual Type: English/Spanish
Additional Office Locations: Irviing. TX
Posted 01/08/2022
Req # 7412

PRIMARY FUNCTION:  Reimbursement Specialist is responsible for analyzing the billing process to determine appropriateness in payment (reimbursement). This position manages all components of claims processing including: 1) coordination of disputed, rejected, and delayed claims, and 2) to problem solve and review returned, disputed or rejected claims from Government and other third party Payers. Additionally, this position is responsible for communicating with billers regarding coding processes to prevent future denials.

REPORTS TO: Revenue Cycle Manager

SUPERVISORY RESPONSIBILTIES: None

FLSA STATUS: Non-Exempt

EXEMPTION CLASSIFICATION: None

NAICS WORKERS COMP: Administrative Support Workers

EEO: Administrative Support Workers

PAY GRADE: Hourly Grade 5

ESSENTIAL FUNCTIONS OF THE JOB: (This list may not include all of the duties that may be assigned.)

 

  1. Processes correspondence related to assigned contracted and/or non-contracted insurance carriers including self-pay accounts.

 

  1. Researches denied and improperly processed claims by contacting assigned carriers to ensure proper processing of said claims. Call and check claim status, work A/R and insurance carrier reports, and insurance denials. Verifies insurance eligibility / PCP / patient benefits to reconcile denied claims.
     
  2. Identifies and corrects any claim processing errors due to data entry, verification, coding and/or posting. Add or update insurance carriers into practice management system. Review the Financial Class and the Insurance Group and verify that they are in the correct financial reporting groups.

 

  1. Resubmits improperly paid/denied claims to the carrier for proper payment in a timely manner.

 

  1. Monitor payer payment policies (bundling process) for each carrier to ensure guidelines are followed.

 

  1. Responsible for validating appeal opportunities, creating appeal letters, generating and submitting individual and/or batch appeals in a timely manner, tracking appeals and recoveries. Follow up on outstanding appeals, and work closely with the appropriate teams to validate contracts.

 

  1. Communicate and escalate denial trends, short payments, or payer policies to Management.

 

  1. Other various duties as assigned, including cross training in other functional areas.

 

*Non patient-facing

 

PERFORMANCE REQUIREMENTS:

 

Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI in accordance with organizational policy, Federal, State, and local regulations.

 

TYPICAL WORKING CONDITIONS:

Indoor Work

Operating Computer

Reach Outward

Manual Dexterity

Lift/Carry 20 lbs. or less

Push/Pull 12 lbs. or less

Sitting

 

Other Physical Requirements

Vision

Sense of Sound

Sense of Touch

 

EDUCATION: High school diploma/GED or equivalent.

 

LICENSURE/CERTIFICATION: None

 

EXPERIENCE: Minimum of 4 years of insurance/collection experience in a medical environment preferred.

KNOWLEDGE, SKILLS & ABILITIES:

  • Knowledge of billing and collection policies and procedures, all types of insurance (HMO, PPO, POS, Medicaid etc.)
  • Skill in defining problems, diagnostics of common coding errors, and impact on claims processing, collection of data, interpreting billing information.
  • Must possess strong interpersonal skills; must be able to communicate effectively with co-workers, the Business Office Manager and must be able to work effectively as a team member within the Business Office.
  • Ability to multi-task in a face paced environment while meeting established production and quality goals/metrics.
  • Strong organizational skills, with ability to effectively prioritize work and daily basis and follow up on open items in a timely manner

 

*Being fully vaccinated against COVID-19 is required unless approved for a medical or religious exemption.

Application Instructions

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