What are the responsibilities and job description for the Insurance Collections Specialist position at Altus Health System?
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Description : Summary :
We are looking for a highly motivated and experienced Insurance Collections Specialist to join our team. The ideal candidate will manage and negotiate the collection of outstanding debts from customers, demonstrating excellent communication and negotiation skills while thriving in a fast-paced environment. This role requires a detail-oriented individual who can ensure efficient claims processing and maintain strong relationships with payers.
Essential Duties and Responsibilities :
Claims Monitoring :
Daily monitoring of claims volume, filing deadlines, open negotiations, and collection efforts to ensure adherence to standardized workflows and processes.
Research and resolve incorrectly paid claims or related issues.
Negotiation Management :
Process and follow up on payer denials, rejected claims, and negotiations in a timely manner.
Open and manage all negotiations, working on pre- and post-negotiation tasks within mandated timelines to ensure optimal payment outcomes.
Schedule and conduct pre- and post-negotiations with insurance carriers and third-party payers as needed.
Tracking and Reporting :
Daily tracking of emails and correspondence related to open negotiation activities to ensure timely responses and scheduling.
Maintain and monitor internal tracking documents for efficiency and timeliness of negotiation and collection work.
Weekly management of negotiation trackers to ensure accounts are up-to-date, payments are processed, and pending accounts are resolved promptly.
Track and report trends or areas for workflow improvement.
Auditing and Training :
Conduct daily, weekly, and monthly audits of workflows and processes to ensure all tasks are implemented and maintained effectively.
Identify areas requiring additional training or education and report to the Associate Director of Revenue Cycle-Collections.
Provide education and training as necessary.
Customer Engagement :
Contact customers to negotiate payment plans and resolve outstanding debts.
Maintain accurate records of all interactions and payment arrangements.
Provide exceptional customer service while adhering to company policies and procedures.
Collaborate with other departments to resolve customer disputes.
Compliance and Targets :
Meet and exceed monthly collection targets.
Stay up-to-date with industry regulations and best practices.
No Surprise Act Compliance :
Handle pre- and post-negotiation tasks related to No Surprise Act claims.
Review claims to identify those requiring negotiation based on corporate guidelines.
Verify proper claim processing and actively negotiate optimal payments.
Track claims at all stages and resolve pending cases not paid when agreements are accepted.
Recommend next-level collections for unresolved negotiations, providing documentation for leadership review and approval.
Requirements :
High school diploma or equivalent (Associate's or Bachelor's degree preferred).
Minimum of 2 years of experience in collections or a related field.
Extensive experience in negotiations, collections, denials management, NSA, IDR, and TDI, preferably in a free-standing emergency room facility setting.
In-depth knowledge of healthcare regulations, privacy laws, and billing requirements.
Strong billing and coding background (experience in free-standing emergency room settings preferred).
Excellent communication, negotiation, and interpersonal skills.
Proficient in Microsoft Office, collections software, and healthcare information systems.
Ability to analyze data, identify trends, and make data-driven decisions.
Strong attention to detail and accuracy.
Experience in process improvement and implementing best practices.
Ability to work in a fast-paced environment and manage multiple tasks simultaneously.
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