Collections Manager - RxFunction

Position Summary
The primary responsibilities of the Collections Manager are to oversee the collection efforts and all correspondence and appeals necessary to collect accounts receivable from third-party payers (e.g., commercial insurers, Medicare and Workers Compensation). Responsible for the development and implementation of collection processes, procedures and policies, as well as the recruiting, hiring and training of collections personnel. Oversee the collection staff on all rebilling of commercial payer claims. Work together with payer contracting team to manage collections at the contracted rates. Stay abreast of payer coverage and billing requirements and changes, and communicate and educate Market Access Manager, Billing Manager and Clinical Relations Manager. Ensure adherence to all regulatory standards and requirements including Medicare, ACHC and HIPAA.

Job Responsibilities
Responsibilities include, but are not limited to, the following:

• Develop and implement Collections processes, procedures and policies.
• Recruit, hire and train Collections staff.
• Oversee the Collections personnel to collect outstanding receivables from third party payers.
• Prepare necessary payer correspondence regarding collection of claims and payment at appropriate benefit level.
• Respond to all third-party payer inquiries, both written and verbal.
• Manage all requests for recoup of overpayment by third party payers.
• Work with the Billing Manager on the ongoing development and use of electronic billing software.
• Work with payer contracting to resolve payment collection issues from contracted payers.
• Work with other team members on all medical necessity claim denials.
• Create, analyze and maintain reports on claim denials and collection issues and utilize these reports to improve front-end procedures and yield better collection outcomes.
• Communicate payer trends to reimbursement team, billing staff and leadership.
• Strategize payer issue resolution with internal teams.
• Other duties as assigned.

Required Qualifications

• Bachelor's degree or equivalent work experience
• 7 to 10 years of medical insurance claims collection experience
• 3+ years of management and supervisory experience with the ability to attract and retain a talented collections team
• Experience with medical equipment billing and collection
• Strong understanding of billing processes
• Strong verbal and written communication skills
• Strong customer service and continuous improvement approach
• Comprehensive knowledge of healthcare regulations and standards, such as HIPAA and Medicare accreditation standards
• Experience with billing software and the Microsoft Office software suite; experience with FileMaker desirable
• Experience with third party insurance contracting desirable