Medical Insurance Collections Specialist

Job Description

Job Description

Our Core Values The culture at Prism Health North Texas is built on our shared Core Values. We make hiring, firing, promotion and performance review decisions based on these values and behaviors, so it is important that you also share these Core Values :

• We are solution seekers. The organization’s founders found solutions even during the AIDS crisis of the 80’s; we remain proactive, thrive on change, and always willing to take the lead.
• We have a can-do attitude . We are flexible, agile, and never say, It’s not my job. We always seek growth, and we are never late but always willing to stay late to see the last patient.
• We are mission driven . We are committed to health equity; recognize all contributions are meaningful and valued. It is never about the me or I, but about the we.
• We care about people . We celebrate diversity, equity, and inclusion; we are kind and practice acts of kindness, all in service to our patients and each other.

General Description :

This position is responsible for collecting payments from third-party medical, dental, and behavioral health payors. Collections activities include denial research, preparing & submitting appeals, and following up on unpaid, partial paid, or incorrectly paid claims.

This includes identifying consistent payer-related payment delays, systematic denials, and communicating patterns to management.

Collections Specialists will also support registration and insurance changes. Responsibilities Job Responsibilities

Specific Responsibilities of the Job :

Monitor claims status for prompt and accurate payment. Follow up on, correct, and / or re-submit rejected, denied, partially paid, and incorrectly paid medical, dental, and behavioral health claims to insurance carriers in a timely manner.

Ensure proper documentation is attached to corrected claims, if needed.

• Respond to payor correspondence; secure and submit additional documentation required or requested by insurance carriers.
• Identify coding, billing, and / or payment errors from EOB / ERA and make indicated corrections.
• Identify consistent payer delays, systematic denials, and other patterns and communicate them to management.
• Demonstrate and apply thorough understanding of insurance plan, Medicare, and Medicaid contracted rates, terms, and regulations to identify inaccurate payments and / or adjustments.
• Investigate, analyze, and resolve denials from insurance carriers.
• Understand and Analyze EOB / ERA information, including co-pay, deductible, co-insurance, coordination of benefits, contractual adjustments, denials, etc.

to verify accuracy of insurance payments and patient balances

• Post charges, payments, adjustments, etc., as assigned.
• Maintain current knowledge on insurance carrier billing requirements and changes
• Accurately and timely update insurance, payment, and claim activity information in EHR / billing system. Demonstrate thorough understanding and effective, accurate use of the EHR / billing system.
• Collaborate effectively with patients, providers, and staff as needed to obtain needed information and to continually improve organizational billing and collections performance.
• Other duties as assigned.

Required Skills Required Knowledge, Skills and Abilities :

• Detail-oriented, independent critical thinking and problem solving skills.
• Demonstrated ability to handle multiple responsibilities and meet tight deadlines in a complex environment.
• Demonstrated knowledge of medical, dental, and / or behavioral health provider reimbursement, medical terminology, ICD-10, CPT, and HCPCS coding.
• Proficiency in MS Word, Excel, and Outlook. Experience with MS Teams preferred.
• Excellent written and oral communication skills.
• Excellent technical and business acumen.

Education and Experience :

• High school or equivalent education required. Associate's degree, Medical Assistant training, or other relevant certificates, certifications, or post-secondary education preferred.
• Minimum of 3 years’ experience in medical collections (medical, dental, and / or behavioral health); billing; coding; and / or denials management required.
• Medical and / or Dental Coding Certification required.

Preferred Qualifications :

• Experience with Athena Centricity, athenaOne, or other Athena products preferred
• Billing / coding / collections experience in a primary care or multi-specialty ambulatory setting preferred
• Work experience in a Federally Qualified Health Center (FQHC) or FQHC look-alike a plus.
19 days ago