Insurance Collection Specialist

Full time Insurance Collection Specialist needed for busy North Oklahoma City billing office

Monday through Friday, no weekends or major holidays

Option to work a hybrid remote schedule

Position Summary:

The Insurance Collection Specialist performs daily activities associated with the timely collection and resolution of accounts receivable. This employee’s main objective is to secure accurate and timely payment towards outstanding patient accounts. Responsibilities include, but are not limited to, direct contract with appropriate payors for resolution of accounts, follow up on outstanding issues associated with assigned accounts and documenting clearly any actions taken on accounts.

Essential Functions:

• Must possess effective and efficient communication, computer and phone skills
• Must be able to obtain resolution of outstanding patient accounts whether that is collection of payment due, refiling of claim, correction of claim issues, and/or any other actions warranted.
• Needs to be able to analyze payments, adjustments, denials, EOBS and other forms of communication from payors to ensure that HPI is receiving correct reimbursement and that we are in compliance with government and/or contract related rules and regulations.
• Expected to stay informed and up to date on any rule or policy change in regards to their current position.
• Must maintain a positive working relationship with any and all entities they may come in contact with on a daily basis. This includes, but not limited to, payors, HPI staff/management, co-workers, clients and customers.
• Must uphold positive public image for HPI.
• Must be able to recognize and address issues with payors on behalf of HPI and be able to articulate the problem to management and/or coworkers.
• Must exercise independent judgment and be able to analyze and report repetitive denials, payor requirement changes and other instances that need to be reported to management so that they can be addressed.
• Employee is expected to be proficient in all systems, programs and processes associated with their current position within the CBO.
• Experience with EPIC a plus.
• Effectively working and cooperating with supervisors, co-workers, and clients.
• Following the directions of supervisors.
• Refraining from causing or contributing to disruption in the workplace.
• Regular and reliable attendance.
• Performs other duties as assigned.

Functional Accountabilities:

• Performs insurance and third party collections. Payors include, but are not limited to, Workers Comp, Commercial Insurance, Managed Care, Medicare, Medicaid and HMOs.
• Contacts third party payors following CBO guidelines established for each payor.
• Ensures claims are received and in-process by appropriate payor.
• Expected to obtain resolution of accounts and collect any and all payments due to our clients.
• Re-file claims to insurance payors as needed by preferred method of submission.
• Correct claim filing issues as needed to include, but are not limited to demographics, insurance listed, insured’s information and other errors found on claim.
• Re-file corrected claims.
• Forward denials or other claim issues [coding, etc.] that could not be resolved through the normal course of collection efforts to the appropriate [now responsible] team in a timely manner.
• Recognize underpayments/overpayments from carriers and handle according to policy.
• Perform additional follow up on assigned accounts within established time frames to include, but is not limited to status of claim, previous messages left, faxes sent, claims refiled and promised payments not received.
• Submit applicable adjustments when warranted and to ensure balance of account is correct.
• Recognize and report payor trends or issues as they are discovered to management and/or co-workers.
• Contact patient/insured when insurance has claim pending for information/action needed from the insured.
• Move account balance due from insurance responsibility to patient responsibility when appropriate.
• Work assigned accounts to completion on a daily basis according to established productivity standards.
• Contact offices, clinics and/or other departments as required to resolve assigned accounts.
• Respond to client requests within 1 business day and/or communicate expected turn around if completion will take longer then 1 day.
• Copy immediate supervisor of any and all emails sent to clients.
• Note clearly and precisely any and all actions taken on an account in the appropriate notes section of current system.

What We Offer

As an organization, one way we care for our communities and each other is by providing a comprehensive benefits package that includes:

• Medical, dental, vision, and prescription coverage
• Life and AD&D coverage
• Availability of short- and long-term disability
• Flexible financial benefits including FSAs, HSAs, and Daycare FSA.
• 401(k) and access to retirement planning
• Employee Assistance Program (EAP)
• Paid holidays and vacation