The Collection Specialist will follow-up with insurance companies to collect outstanding accounts for which payment has not been received in response to the claims submission process, either electronically or.by paper. The Specialist will be assigned payer groups of outstanding patient accounts. Various methods of follow-up will be used including the PCS System of IDX. The Specialist must have expertise in insurance follow-up processing and be knowledgeable in CPT and ICD-9-CM coding as well as have an understanding of the JHOC registration process and be able to recognize and resolve incorrect demographic and insurance registration. The Specialist must have an understanding of claims submission requirements for all payers to expedite payments as well as knowledge of appeals and rejections processing. This position requires excellent communication skills coupled with patience and fortitude.
Essential Job Functions
Identifies problem issues on outstanding patient accounts. Works to resolve issues so that invoice will be processed by payer or balance moved to patient responsibility.
Identifies insurance issues of primary vs secondary insurance, coordination of benefits, eligibility and any other issue causing non-payment of claims. Contacts the payer or patient as appropriate for corrective action to resolve the issue and receive payment of claims.
Alerts the manager to problems with specific carrier payments, improper rejections or non-compliance with Maryland law when the issue cannot be resolved or if there seems to be a trend with a particular payor.
Handles patient account inquiries and assists patients with filing or re-filing of claims including secondary insurance.
Communicates with patients, physicians and insurance companies to resolve accounts. This includes resolving issues identified through incoming correspondence.
Works system collection reports and works files such as: aged trial balances, data searches, paperless collection system (PCS).
Prints and mails/faxes claim forms and statements as requested by patients, insurance companies or other authorized third parties.
Confirms credit balances and gather necessary documentation for processing refund. Prints medical notes from the EPR system when needed for the processing of claims. Working knowledge of the IDX billing and EPIC registration systems.
Special projects assigned by supervisor. Assemble invoices with a common problem into excel file for submission to PUM. Prepare explanation of problem and recommended solution in Word document. Monitor invoice activity until problem is resolved.
Other tasks: Process daily mail, edit reports, file or pull EOB batches. Other tasks as assigned by supervisor.
1 year medical billing experience or demonstrated knowledge of medical billing concepts.
Additional education may substitute for required experience, to the extent permitted by the JHU equivalency formula.
JHU Equivalency Formula: 30 undergraduate degree credits (semester hours) or 18 graduate degree credits may substitute for one year of experience. For jobs where equivalency is permitted, up to two years of non-related college course work may be applied towards the total minimum education/experience required for the respective job.
Experience in Radiology specialty area.
Understanding of third party payer issues.
IDX and Microsoft experience.
Excellent analytical and communication skills.
In-depth knowledge of medical insurance industry and professional fees.
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