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Revenue Cycle Specialist – Collector


Position Control #

# 09-5027-074



Report To: Billing & Coding Administrator


ADA: Full time position.  Ability to sit for long periods of time and/or stand periodically during work day and lift up to 30 lbs., when necessary.  Computer data entry a portion of job duty.


OSHA: Must adhere to universal precautions, to include blood borne pathogen protection, at all times.


Primary Duties:


  • Processes a secondary Medicaid for paid insurance claims using the ASAP system weekly. 
  • Re-bill unpaid crossover Medicare and Medicaid claims on the ASAP system from the monthly A/R list. 
  • Process Medicare Fee – For – Service (x-ray, EKG, and hospital) claims bi-weekly.
  • Works Medicaid pending newborn OB delivery monthly, to assign and transfer to Medicaid or if not eligible to responsible party. 
  •  Review MMA 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 claim, 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 system.
  • Follow-up on outstanding A/R that is (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 “Comments” section in the A/R spreadsheet for all payers 60 and over. 
  • Prepare monthly A/R reports 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. Report any new changes to Administrator.
  • Keeps current with new insurance and billing policies, as well as refer to the Insurance Provider Handbooks, and Medicaid Manuals.
  • Monthly, prepares sliding fee scale (SFS) contractual write – off report, checks Medicaid  and re-classes and rebills Medicaid eligible and process contractual write-offs


Secondary Duties:


  • Research and apply on – account payments monthly.                                      
  • Prepares monthly report for patient accounting meetings of Medicaid rejections, Medicaid HMO rejects and Center input errors, providing examples to them when necessary for training. 
  • Prepares quarterly Medicare credit balance report for each location and submit timely. 
  • Assists in answering the phone and employee phone queries.



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.


Additional Notes


This job description is not intended to be all-inclusive, and the employee will also perform other reasonable related business duties as assigned by supervisor.


  • This organization reserves the right to revise or change job duties and responsibilities as the need arises. This job description does not constitute a written or implied contract of employment.


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