AR Collection Specialist - Surgery Billing & Coding Expertise

About Plutus Health Inc.:
Plutus Health Inc. is a leading provider of Revenue Cycle Management (RCM) services, recognized for its SOC2 Certification and commitment to delivering exceptional financial performance for healthcare providers. We serve a diverse range of specialties, including surgery, with innovative solutions aimed at improving our clients' revenue cycle outcomes. Plutus Health Inc. has been recognized among the fastest-growing private companies in America and ranked 100 in the Dallas area, solidifying our reputation for excellence in healthcare RCM.

Job Summary:
We are looking for a highly skilled AR Collection Specialist with deep expertise in surgery billing and coding. This role demands a professional who is experienced in handling complex surgical claims, ensuring accurate coding, and maximizing collections. The ideal candidate will be well-versed in surgery-specific billing processes, insurance regulations, and denial management, and will play a crucial role in the overall revenue cycle management.

Key Responsibilities:

• Surgical AR Collections: Manage all aspects of accounts receivable collections with a focus on surgery claims, ensuring timely resolution of unpaid claims.
• Surgery Billing & Coding: Review and process claims with accurate coding for a wide range of surgical procedures, including complex surgeries such as [e.g., cardiovascular, orthopedic, general surgery].
• Denial Management: Investigate and resolve denied or underpaid claims related to surgeries, working with insurance companies for accurate appeals and resubmissions.
• Revenue Cycle Optimization: Collaborate with the billing and coding team to streamline the billing process and improve collections specific to surgical services.
• Insurance Liaison: Communicate with insurance companies to clarify claim status, correct any discrepancies, and escalate issues when necessary.
• Patient Account Resolution: Assist with patient accounts when necessary, addressing any coding or billing issues related to surgery charges.
• Compliance: Ensure all claims, billing activities, and follow-ups are compliant with insurance policies, payer guidelines, and regulatory requirements.
• Reporting: Generate and present AR reports specific to surgery billing and collections, including aging reports, denial trends, and cash flow performance.

Qualifications:

• Experience: Minimum of 4-5 years of AR collections experience, with at least 2-3 years focused on surgery billing and coding.
• Knowledge: Strong understanding of surgery-specific coding (CPT, ICD-10, and HCPCS codes), payer policies, and regulatory guidelines in surgery billing.
• Technical Proficiency: Experience with medical billing software and electronic health records (EHR) systems, with a focus on surgery-related processes.
• Communication Skills: Excellent verbal and written communication skills, with the ability to interact effectively with insurance payers, healthcare providers, and internal teams.
• Attention to Detail: Proven ability to handle complex claims, identify discrepancies, and manage detailed follow-ups to maximize collections.
• Problem-Solving: Analytical and resourceful in resolving denied claims and underpayments, particularly in surgery billing scenarios.
• Education: Certification in Medical Billing and Coding (e.g., CPC, CCS) preferred but not required; high school diploma or equivalent is mandatory.

Why Join Plutus Health Inc.?

• Surgical Expertise Focus: Be part of a company that specializes in high-value surgery AR and plays a key role in helping healthcare providers maximize their revenue.
• Career Growth: Opportunities for continuous learning, professional development, and career advancement within the healthcare RCM industry.
• Supportive Environment: Collaborate with a highly skilled team dedicated to achieving operational excellence.
• Competitive Compensation: Attractive salary and benefits package, including health insurance, paid time off, and more.