What are the responsibilities and job description for the Revenue Cycle Specialsit-Collector position at USPI?
ESSENTIALS DUTIES AND RESPONSIBILITIES:
· Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers including self-pay to obtain maximum reimbursement.
· Manage daily work queue to prioritize high dollar claim balances.
· Review & work incoming insurance and patient correspondence including refund requests.
· Send appeals when appropriate or provide the requested medical documentation.
· Ability to review medical documentation to justify medical necessity.
· Take incoming patient phone calls to resolve inquiries, billing issues, or outstanding balances.
· Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents.
· Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD’s) for claim resolution.
· Negotiate payment amounts for procedures with Third Party Administrators for out of network providers.
· Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.
Required Skills:
· 2 years of revenue cycle
- Ability to read and interpret insurance explanations of benefits and managed care contracts.
- Must communicate effectively, both verbally and in writing, with internal and external clients.
- Must be able to multi-task and handle competing priorities while meeting or exceeding deadlines.
- Knowledge or experience working with a variety of health care insurance payers is preferred.
- High School Diploma or equivalent.
Required Experience:
General knowledge of the healthcare industry insurance/EOB payment process
