Collections Specialist

The Billing Collections Specialist is responsible for managing the collection of outstanding balances from private pay clients, third-party insurance providers, Medicaid, and other funding sources. This role involves processing electronic claims, tracking payments, resolving discrepancies, and maintaining accurate records. The Specialist plays a vital role in ensuring the financial health of the agency by addressing collections efficiently and implementing solutions to reduce payment delays.

RESPONSIBILITIES:

1. Billing and Claims Management:

• Process and monitor electronic billing for Medicaid, Managed Care Organizations (MCOs), private insurance, and private pay accounts.
• Accurately submit claims using billing software and ensure service codes (e.g., HCPCS and CPT codes) are correctly applied.
• Track the status of claims from submission through payment and identify unpaid or underpaid claims for follow-up.
• Review Explanation of Benefits (EOBs) and remittance advices to verify payments, address denials, and resolve discrepancies.
• Ensure compliance with federal, state, and payer-specific regulations to avoid billing errors.

2. Collections and Follow-Up:

• Proactively follow up on outstanding accounts receivable (A/R) to ensure timely collections.

= Contact insurance companies, clients, and responsible parties to resolve overdue balances.

• Research denied or rejected claims, identify errors, and submit corrections for resubmission.
• Document all collection activities, including calls and correspondence, in the billing system.
• Generate and send payment reminders, statements, and final notices as needed.
• Negotiate and establish payment plans with private pay clients while maintaining positive client relationships.

3. Problem Solving and Efficiency:

• Investigate billing errors or discrepancies promptly.
• Analyze trends in claim denials to identify root causes and implement preventive measures.
• Act as a liaison between the billing department and insurance companies to ensure effective communication.
• Identify and implement opportunities for process improvement to increase billing efficiency.

4. Compliance and Reporting:

• Maintain up-to-date knowledge of service codes, reimbursement rates, and payer-specific requirements.
• Prepare and submit weekly A/R reports to the Billing Manager and Administrator, detailing collections progress and outstanding balances.
• Monitor aging reports to prioritize collection efforts on high-dollar or long-overdue accounts.
• Ensure all documentation complies with company policies, HIPAA regulations, and ethical standards.

QUALIFICATIONS

• Strong analytical and problem-solving skills.
• Excellent written and verbal communication abilities.
• Detail-oriented with the ability to manage high volumes of claims and payments.
• Proficient in billing software (e.g., HHAeXchange, AlayaCare) and Microsoft Office Suite.