[Hiring] Collections Specialist II @Spartanburg Regional Healthcare System

Role Description

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.

Qualifications

• High School Diploma or equivalent
• 3+ years medical office or medical billing/collections experience in a hospital or centralized billing setting
• Knowledge of CPT, HCPCS, and ICD-9/10 codes
• Good working knowledge with insurance explanation of benefits (EOB) and comprehensive understanding of remittance and remark codes
• Familiarity with multiple payer requirements for claims processing
• Solid skills with Microsoft Office with a focus on Excel and Word
• Good communication skills

Requirements

• Only Applicants from the following states: Alabama, Arizona, Connecticut, Delaware, Florida, Georgia, Indiana, Kansas, Kentucky, Louisiana, Maryland, Michigan, North Carolina, Pennsylvania, Rhode Island, South Carolina, Virginia, West Virginia, Wisconsin

Preferred Requirements

• Associates degree
• 4+ years’ experience in a centralized billing setting
• 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

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
• Complete all error corrections and insurance updates to the facility/professional claim to resolve issues preventing payment
• 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
• Work in different systems including claims eligibility, online payer claims system, as well as all AR management systems
• Escalate non-denial payer issues, including review of outstanding AR greater than 90 days, and share 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
• Ensure claim has been received and is processing with payer within the timely filing period as defined by departmental goals and insurance guidelines
• 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
• Have working knowledge of registration, payment posting, error correction and other billing functions
• Exhibit professionalism and good customer service skills
• Maintain confidentiality and handle sensitive information
• Respond to emails within 24/48-hour turnaround time from receipt
• Utilize time and manage work processes to ensure organizational and departmental expectations are met
• Other duties as assigned