GENERAL SUMMARY OF DUTIES:

The primary responsibility of the Medical Collection Specialist is to ensure effective collection of all patient accounts. This is a hybrid/remote position requiring internet speed of 5MB upload and 5MB download.

REQUIREMENTS:

• High School Diploma
• 3 to 5 years previous experience in office billing and collections environment (CBO)
• High degree of attention to detail and accuracy
• Ability to prioritize work assigned independently and multi-task
• Knowledge of insurance, billing terms, CPT/ICD10, coding and DRG
• Knowledge of modifiers usage and CCI edits
• Strong medical insurance background
• Working knowledge of MS Office applications which includes Outlook, Word, Excel, and Power Point
• Critical thinking skills
• Spine/Orthopedic surgery experience preferred
• EPIC experience preferred
• Minimum of three years’ experience in medical collections
• Hospital Billing/Collections preferred

ESSENTIAL FUNCTIONS:

• Perform extensive insurance claim follow-ups for insurance denials, appeals, and perform next steps a must
• Ability to utilize multiple patients accounting and billing applications including but not limited to claims clearing house systems, payer websites
• Ability to interact with the payer representatives, HIM, Insurance Verification and Access Service departments
• Participates in group meetings and /or various committees
• Ability to effectively present information regarding denial trends, and present to management
• Ability to read, understand, interpret and resolve payer denials and EOB's
• Understanding of copays, coinsurance, deductibles, and denial codes
• Ensure denial reviews, claim follow-ups are conducted in a timely manner in accordance with payer timely filing limits
• Correct claims and file appeals with supporting documents to insurance companies, by phone, electronically or mail
• Ability to work receivables to investigate and resolve denials and partial payments
• Ability to calculate reimbursement per payer contract
• Maintains a positive attitude toward their position and responsibilities

PHYSICAL DEMANDS:

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential
• While performing the duties of this job the employee is frequently required to sit, converse, and listen; use hands to touch, handle, or feel objects, tools, or controls; and to reach with hands and arms. Specific vision abilities required by this job include close vision and the ability to adjust
• The employee must be able to lift and/or carry over 20 pounds on a regular basis and be able to push/pull over 25 pounds on a regular
• The employee must be able to stand and/or walk at least five hours per

WORK ENVIRONMENT:

• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential