Revenue Cycle Specialist-Collector

• Process electronic and paper medical and dental claims submission, review for errors and completeness and make necessary corrections. Ensure electronic claims are received by EDI vendor. Give railroad Medicare and HMO with authorization claims to Medicare/Medicaid biller.
• Bill secondary insurance carriers. Attach copy of Primary EOB or Medicare remittance provided by Payment Processor.
• Prepare and bill “special contract” invoices according to contract terms. Submit monthly billings to PAM for review and approval, (i.e., TCHC, Martin County Health Dept.).
• Post all non-payment EOBs for deductibles and apply to any SFS, daily. Ensure Worklist, EHR $0 Athena report and all $0 EOBs for the month are posted and reviewed prior to month end close. Investigate denials on EOBs, request information needed to reprocess claims, make necessary corrections, and resubmit claim according to Insurance Provider Handbook and contracts. Document reason and date of re-bill in patient EHR.
• Review insurance company correspondence, acquire information to respond to insurance companies request, and reply or re-bill when possible. If determined to be Patients responsibility – note on the correspondence, and forward to Collector, (i.e., Patient has failed to forward requests for information to the insurance company.) If patient is not covered under policy, and there is no other coverage, re-class to pay patient and apply SFS. Document in “Notes” section in MIS system.
• Follow-up on outstanding third-party A/R on a monthly basis for special programs sixty (60) days and over by working insurance pending reports and month end aged A/R by payor listing. This includes phone calls and/or written correspondence. Document collection activities in the “Notes” section in the system (payor codes 60 and higher).
• Prepare monthly report for patient accounting meeting with examples of center input errors that cause the claim to be rejected/re-billed/reprinted and electronic billing errors. Prepare copies of errors for centers to review.
• Review and fully understand Insurance policies guidelines for correction, submission, resubmission and appeals.
• Keep current with new insurance and billing policies, as well as refer to the Insurance Provider Handbook, Medicare Benefit Policy Manual or online Insurance resources for when additional information when needed.

Secondary Duties:

• Assist in answering patient and employee phone inquiries. Assist in problem solving third party issues.
• Coordinate with Credentialing Clerk to ensure timely, accurate set up of providers for FCHC participating plans.
• Maintain 1500 medical/dental claim form inventory and window envelopes.

Minimum Qualifications: 

• High School Diploma.
• Two (2) years’ experience in medical insurance claims processing.
• Must be able to analyze data and report it effectively
• Must have excellent interpersonal skills and is able to communicate effectively.

Skills and Abilities: 

• Good telephone etiquette and organizational skills.
• Be able to handle diversified duties.
• Knowledge in Microsoft Excel, Word, and PowerPoint preferred.
• Must be computer literate and have the aptitude to learn new programs as changes occur