Collections Specialist FT - United Surgical Partners International

Center for Advanced Surgery is seeking a Collections Specialist to join our team!

Job Summary:

Under the direction of the Business Office Manager, the Collections Specialist is responsible for:

• Follow up on delinquent surgery center claims (working an expected number of claims per day) - majority of claims will have been submitted to various insurance carriers electronically.
• Knowledge of how to interpret a managed care contract, Medicare and Medicaid and Workers Compensation claims is a must. Tools will be given to calculate allowable and required to determine appropriateness of reimbursement and appeal claims as necessary.
• Extensive contact with insurance carriers of all types, as well as communication with patients regarding out of pocket amounts is required.
• Identification of accounts that have been either under or over paid, issuing credit balance information either to the insurance carrier or the patient.
• All of these practices done in a professional and communicative manner, per policies and procedures, guidelines, internal control measures and established goals.
• The Collection Specialist must be a team player and have ability to communicate well with direct reports, patients, customers, insurance carriers, etc.
• Ability to manage accounts worked independently, and in a productive manner.
• Must project a professional demeanor and appearance while maintaining the confidentiality of the surgery center and patients.
• Works well in stressful environment and in situations that demand patience.
  Projects a professional demeanor and appearance while maintaining the confidentiality of administration, patients, physicians and employees.
• Works under stress and in situations that demand patience and tact while providing impeccable service.

• High School Diploma or equivalency.
• 1-2years of previous medical claims experience
• Experience in government payer claim adjudication (Medicare, Medicaid, VA, Tricare) and commercial payers (BCBS, Aetna, Cigna, UHC, etc.)
• Familiar with reading contracts and have the ability to apply those rules to an EOB and determine a follow up/resolution path.
• Familiar with grievance and appeals process.
• Ability to read an EOB
• Strong interpersonal communication skills, verbal and in writing.
• Must have experience with Windows applications and able to manage Excel spreadsheets (edit, sort, filter, etc.)
• Medical terminology.
• Comfortable utilizing critical thinking skills.
• Prefer previous experience working with Advantx (Patient Accounting System).
• Prefer previous experience with Electronic Health Record system, but will train.

USPI complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.