Medical Collection Specialist

The primary responsibility of the Medical Collection Specialist is to ensure effective collections on all patient accounts.

Minimum Qualifications      

• 2 years previous experience in ASC/Hospital billing and collections environment and/or accounting finance experience required
• High degree of attention to detail and accuracy required
• High school diploma or equivalent
• Working knowledge of MS Office applications which includes Outlook, Word, and Excel
• Ability to read, understand, interpret and resolve payer denials
• Ability to research payer regulations and determine appropriate collection action
• Ability to utilize multiple patients accounting and billing applications including but not limited to FISS/GPnet direct data systems (medicare), claims clearing house systems, payer systems, etc.
• Ability to calculate reimbursement per payer contract
• Ability to interface with the staff at the insurance carriers, HIM, and Access Service staff
• Ability to read, write and understand documents, correspondence, and memos
• Ability to effectively present information one-to-one and in group situations to customers, clients, and other employees in the organization
• Ability to apply common sense understanding to carry out instructions furnished in written, oral or diagram form
• Critical thinking skills required
• Effective PC skills

Preferred

• Minimum of 2 years' experience in medical collections preferred

 Essential Functions

• Makes follow-up phone calls on accounts with outstanding insurance balances
• Maintains standards to ensure systematic, consistent and timely collection follow-up
• Current productivity standard is 40 accounts per day or as assigned
• Follow-up on accounts with outstanding balances that do not have appropriate payment arrangements
• The Aged Trial Balance report will be printed every other week, or as assigned by BOM, and every outstanding account should be worked
• All notes regarding written and/or verbal communication on the account will be maintained in the “MEMO” file on the patient’s account and should include the following:
  • Date of collection work
  • Time of collection work
  • Telephone # of contact
  • Full name of contact
  • Location of contact (home, work, employer, insurance co.)
  • Complete summary of conversation
  • Next follow-up date based on payment promises
  • Collector’s initials
  • Reimbursement calculation
• Insurance Due Accounts should have the initial follow-up call made 14 days following the date of service.  Subsequent follow-up calls should be made every 30 days until the balance is paid.  Insurance Due balances not paid within 60 days from date of bill should have appropriate actions taken which could include transferring to patient due and billed to the patient
• Maintain interaction with Health Information Management Department and relative team members to expedite issues
• Works in conjunction with other staff to successfully meet internal goals
• Participates in group meetings and /or various committees
• Makes suggestions on workflow improvements
• Notifies BOM of any collection issues
• Maintains a positive attitude toward their position and responsibilities
• Additional job duties as assigned

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job the employee is frequently required to sit, converse, and listen; use hands to touch, handle, or feel objects, tools or controls; and to reach with hands and arms. Specific vision abilities required by this job include close vision and the ability to adjust focus.

The employee must be able to lift and/or carry over 20 pounds on a regular basis and be able to push/pull over 25 pounds on a regular basis.

The employee must be able to stand and/or walk at least five hours per day.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.