Insurance Collector 1

KICK for the GOAL

OrthoArkansas' core values

KINDNESS

People are happier after interactions with you because you are kind and pleasant.

INTEGRITY

Always doing the right thing, especially when no one is looking.

CONSCIENTIOUSNESS

Strive for excellence in all that you do, paying special attention to the details that make a difference in patient care and teamwork.

KNOWLEDGE

Be a lifelong learner.

Position Overview:

At OrthoArkansas, our Insurance Collectors are crucial to ensuring the timely and accurate reimbursement of claims, directly contributing to the clinic's financial health and supporting providers in maximizing revenue. In this role, you’ll handle claims, resolve soft denials, assist with appeals, and collaborate with both internal teams and insurance carriers to efficiently address issues. You’ll join a dynamic, supportive team working together to ensure a seamless experience for both patients and providers.

Key Responsibilities:

1. Claims Management:

• Manage payer-specific buckets, processing an average of 60 claims daily.
• Review and investigate unpaid claims to ensure timely reimbursement.
• Assist with drafting appeal letters and communicate with insurance carriers regarding denied claims.
• Identify and resolve issues like duplicate charges, incorrect coding, or registration errors, initiating corrections as needed.

2. Denial and Error Resolution:

• Resolve insurance refunds and soft denials, ensuring thorough follow-up.
• Utilize payer websites (e.g., AHIN, Medicaid, CMS) to address claim discrepancies.
• Communicate with the Reimbursements Manager before writing off claim balances, ensuring all options have been explored.
• Research insurance coverage policies to ensure correct claims processing and optimize reimbursement.

3. Documentation and Communication:

• Maintain accurate, up-to-date documentation in the billing system, tracking each action and outcome.
• Respond promptly to calls, emails, and inquiries from OrthoArkansas staff regarding claim or account status.
• Maintain and update physician dashboards, providing transparent and timely insights into claims processing and revenue.

4. Insurance Relations and Meetings:

• Communicate with insurance companies via mail and online portals to resolve outstanding claims.
• Attending local insurance meetings as necessary to stay updated on policy changes and coverage updates.

5. Additional Duties:

• Perform other related duties as assigned to support the efficiency of the billing and reimbursement process.

6. Evolving Responsibilities:

As healthcare evolves, so do we! Our Insurance Collectors are proactive and adaptable, tackling complex claims, high-priority denials, and leading process improvements to maximize reimbursement.

Claims Resolution:

• Handle escalated and long-outstanding claims.
• Address denials related to medical necessity, coding, or policy issues.
• Collaborate with coding specialists or providers to resolve complex claim issues.
• Review and interpret insurance contracts and payment policies.

Appeals and High-Priority Claims:

• Assist with appeals for denied claims.
• Manage high-dollar or high-priority claims, leading the resolution of complex or high-volume denial issues.

Mentorship and Collaboration:

• Train and mentor junior follow-up specialists, fostering growth and consistency.
• Collaborate with departments (e.g., coding, finance) to streamline processes and resolve systemic issues.

Process Improvement:

• Develop strategies to improve follow-up efficiency and reduce denial rates.
• Report on follow-up outcomes and identify areas for continuous improvement.

Qualifications:

• Education and Experience:
  • High school diploma or GED equivalent.
  • 0 to 6 months of related experience and/or training, or an equivalent combination of education and experience.
  • Experience with orthopedic procedures, diagnoses, and procedure codes preferred, but not required.
• Skills and Abilities:
  • Strong organizational skills with meticulous attention to detail.
  • Excellent verbal and written communication for professional interaction with patients, providers, insurance companies, and team members.
  • Ability to thrive in a fast-paced environment, balancing multiple tasks while maintaining accuracy.
  • Problem-solving and decision-making abilities.
  • Strong interpersonal skills and a commitment to maintaining HIPAA confidentiality.
• Preferred Skills (Not Required):
  • Proficiency in medical coding (CPT, ICD-10) and insurance billing practices.
  • Advanced understanding of insurance policies and reimbursement processes.
  • Analytical skills for identifying patterns in denials and follow-up needs.
  • Expert knowledge of medical billing, coding, and insurance reimbursement.
  • Leadership and team management experience.

Software Skills:

• Advanced: Alphanumeric data entry.
• Intermediate: 10-Key, database management, spreadsheets, word processing.
• Basic: Accounting and contact management.

Additional Details:

• Performance Expectations: Ensure timely and accurate claims processing while maintaining clear communication with insurance carriers and OrthoArkansas staff.
• Professional Development: Opportunities for growth, staying current with insurance policies, billing processes, and reimbursement strategies.

Join OrthoArkansas as an Insurance Collector and become part of a dedicated team committed to ensuring smooth revenue cycles and improving the financial health of our providers. This role offers a chance to grow professionally while making a significant impact in a dynamic healthcare environment.