Medical Claims Collections Specialist/AR- Behavioral Health

Job Title: Medical Claims Collections Specialist/AR- Behavioral Health

Exemption Status: Non-Exempt

Location: Port Saint Lucie, FL

Position Summary

Join our dynamic team as an Accounts Receivable Collections Specialist, where you will play a crucial role in the timely and precise follow-up of health insurance claims with various insurers. This position involves researching authorizations, collaborating with facilities and providers, managing denied claims efficiently, and resubmitting claims when necessary. You'll also be responsible for reviewing and appealing denials or pending payer retractions while adhering to departmental policies and procedures. Additionally, you'll provide essential support to the EDI/Claims Specialist and Charge Capture Coordinator during absences or special projects.

Primary Responsibilities

• Proactive Follow-Up: Conduct daily follow-up on assigned A/R accounts as outlined in the work list, ensuring timely resolution.
• Denial Management: Address denials immediately for assigned accounts to prevent timely filing issues and enhance cash flow.
• Collaborative Teamwork: Work seamlessly with colleagues to manage workloads, accommodate time off requests, and tackle special projects.
• Cross-Functional Coordination: Collaborate with EDI/claims, charge coordinators, cash applications specialists, and patient advocates to ensure a smooth revenue cycle.
• Communication Excellence: Report all issues or potential challenges to leadership promptly to maintain operational integrity.
• KPI Achievement: Meet key performance indicators and adhere to all standard operating procedures (SOPs), policies, and compliance standards related to Revenue Cycle Management and payer requirements.
• Versatile Support: Assist with other office duties as assigned by management to foster a collaborative work environment.
  
  

Position Requirements:

Education/Experience

• High School Diploma or GED required.
• Preferred three years of experience in Accounts Receivable collections or related functions.
• Proficient understanding of reading and interpreting insurance EOBs.
• Familiarity with payer rules, coordination of benefits, and the collections and appeals processes for claims.
  
  

Knowledge/Competencies & Skills:

• Strong understanding of ICD-10 and CPT-4 codes preferred.
• Comprehension of medical terminology is beneficial.
• Familiarity with NCCI guidelines and federal/commercial insurance policies preferred.
• Excellent written, verbal, and interpersonal communication skills.
• Proficient in Microsoft Excel and Word.
• Accurate and efficient data entry skills with a strong attention to detail.
• Proficient computer software and database skills.
• Strong analytical abilities to navigate complex billing scenarios.
• Ability to multitask and thrive in a fast-paced, high-volume environment.
• Familiarity with billing software systems is preferred.
  
  

Physical Demands:

• Regularly required to sit for 4-7 hours/day and stand for 1-3 hours/day.
  
  

Job Type: Full-time

Pay: $17.50 - $22.00 per hour

Work Remotely: No

Join us and contribute to our mission of delivering exceptional service in the healthcare revenue cycle!

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