Medical Collections Specialist

Job 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.

Education

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

Experience / Qualifications

• Demonstrated knowledge of medical terminology.
• Computer experience and working knowledge of MS office suite, KIPU and CollaborateMD 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.

Position Summary

• 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.

Other Responsibilities

• 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.

Additional Job Requirements

• Performs other job-related duties within the job scope as requested by RCM Management.
• Protects confidential and protected patient health information and maintains strict confidentiality in accordance with HIPAA Laws, regulations and company policy.
• Presents a positive, professional appearance and conveys a professional demeanor in the performance of assigned duties.
• Embodies the values of the organization’s mission, vision, and goals always.
• Represents Phoenix Behavioral Health in a positive and professional fashion and makes all individuals feel as comfortable as possible.
• Conducts all business in a professional manner maintaining respect for all individuals.
• Complies with departmental and company-wide policies and procedures.
• Maintains constant awareness of potential safety hazards ensuring necessary safety precautions.
• Reads and complies with established Organization’s and Patient Accounts policies and procedures.
• Exemplifies the highest levels of quality and integrity aligned with the organization’s standards, policies and procedures.

Physical Requirements

• Minimal physical effort.
• May require some lifting - up to twenty pounds.
• Close vision, color vision, and ability to adjust focus are required.
• Moderate noise levels.
• Works in a clean, well-lighted and ventilated environment with no apparent exposure to physical hazards.

Threshold Requirements

• These threshold requirements are required and completed yearly basis
• Annual Joint Commission mandatory education requirements, in-service and health requirements including attendance at new employee orientation
• TB/PPD Surveillance Program
• Maintenance of required professional licensing and/or certification(s)

Job Type: Full-time

Pay: $20.00 - $22.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Work Location: In person

Salary : $20 - $22