POSITION SUMMARY: Under the direct supervision of the Manager of Revenue Cycle, the Medical Collections Specialist is responsible for all components of payer and patient collections for all Phoenix Behavioral Health entities. Collaborates with the Manager of Revenue Cycle to establish, design, implement, and enforce policies and procedures related to collections. Applications utilized include: Kipu, CollaborateMD, Codify, Monday Board, Excel, Word, Power Point.

GENERAL REQUIREMENTS/QUALIFICATIONS

COMPETENCIES:

• Demonstrated knowledge of medical terminology.
• Computer experience and working knowledge of MS office suite, KIPU and Collaborate MD experience preferred.
• Medical Business Office experience required, Substance Abuse experience preferred.
• Must be able to communicate effectively in English (verbal/written).
• Knowledge of Medicare, Medicaid, managed care contracts, commercial plans, and other government payers.
• Demonstrated knowledge of government and third-party regulations and standards.
• Experience with HIPAA compliance standards and guidelines required.

• Demonstrated knowledge of payer reimbursement procedures and methodologies.
• Ability to work independently while effectively managing different priorities and projects.
• Ability to effectively present information to management.
• Ability to define problems, collect data, establish facts, and draw valid conclusions that drives process improvement, quality, and productivity.
• Demonstrated ability to work independently in a fast-paced environment in an efficient and effective manner.
• Requires daily contact with insurance companies and patients via email, telephone, portal, mail, and/or in-person.

ESSENTIAL FUNCTIONS and BASIC DUTIES

• Ensures the timely coordination of collection activities for assigned accounts/payers via internal and external databases, payer portals/websites, and telephone.
• Researches, determines, and initiates appropriate collection actions to resolve denied/rejected invoices and prepares payer corrections and/or appeals in accordance with payer plan requirements using electronic and paper processes.
• Collaborates with the Manager of Revenue Cycle regarding any potentially negative collection trends and brings all outstanding issues to the attention of the Manager of Revenue Cycle.
• Responsible for strict adherence to CMS 1500 and UB-04 guidelines.
• Demonstrated knowledge of revenue code usage, contractual adjustments, payment transactions, and credit balance resolution.
• Ability to train and assist other Clinical Collection Specialists.
• Responsible for adhering to productivity and quality standards of Phoenix Behavioral Health.
• Maintain positive working relationships with Revenue Cycle, Medical, and Clinical Teams.
• TEAM PLAYER and willing to be diversified in job duties. Performs other job-related duties as required.
• Supports the Manager of Revenue Cycle other RCM Management by assisting with research of issues arising from payer denials and audits.
• Supports the Manager of Revenue Cycle and other RCM Management by presenting recommendations of QA activities geared to address specific areas of high risk to revenue.

MINIMUM EDUCATION AND REQUIREMENTS:

• High School Graduate or Equivalent required.
• College level coursework preferred.
• Two to four years of professional and/or facility business office experience that includes collections preferred.

PHYSICAL DEMANDS/ WORK ENVIRONMENT REQUIREMENTS:

TYPICAL WORKING CONDITIONS:

Work is typically performed in an office environment. Will spend majority of time working on a computer and using office equipment. Frequently interacts directly or over the phone with stake holders during the workday. Must have the ability to work the hours and days required to complete the essential functions of the position.

EMPLOYER’S RIGHTS:

This job description does not list all the duties of the job. Incumbents may be asked by their supervisor to perform other duties. Incumbents will be evaluated in part based upon their performance of the tasks listed in this job description.

The Company has the right to revise this job description at any time. The job description is not a contract for employment, and either you or the Company may terminate employment at any time, with or without cause, with or without notice (subject to applicable laws).