Manage Care Hospital Collection Rep - FFAM360 Heathcare

IN OFFICE = ATLANTA, GA

The Medical Collection Hospital Specialist is responsible for the collections of Inpatient and Day Program insurance claims payment and account resolution. Essential to this position is the ability to manage all Insurance Follow up for maximum insurance reimbursement. To include outbound and inbound insurance carrier calls, reprocessing claims, drafting appeals, working and resolving denied claims, transferring balance to Self-Pay when applicable. The position also requires timely response for request from the insurance carrier via correspondence for electronically received request. The incumbent will assist in the clarification and development of process improvements and inquiries, assure payment or account resolution from all sources are recorded and reconciled timely in order to maximize revenues.

Principal Accountabilities:

1. Follow Up –

• Understanding and staying informed of the changes with procedures, billing guidelines, and laws for specific insurance carriers or payers.
• Initiating collection follow up on all unpaid or denied claims with appropriate insurance carrier.
• Monitors charges for obvious errors.
• Research, appeal, and resolve all unpaid claims.
• Actively follow up and collect on all electronic claims and paper claims, including resolution of any billing errors assigned following established procedures
• Timely response to all correspondence received from insurance carrier
• Accurately documents account history for all accounts with details provided by insurance carrier or payer.
• Maintains a positive relationship with payers while completing appropriate follow-up for payment.
• Coordinate collection process, to include any projects from Vendor accounts.
• Posts adjustments and/or transfer of responsibility, as necessary.
• Communicate appropriately to clinical areas when information is needed that would delay payment
• Obtains medical records from appropriate Release of Information system in a timely manner and ensures all that is needed for payment is attached and submitted as requested.
• Reports any identified issues to management.
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Ensures all paper claims are mailed to the appropriate carrier and address.

1. Reporting –

• Provide data and support to management from on-going projects and in identification of any issues, including variances due to contract issues.
• Communicates any updates provided from payers regarding reimbursement.
• Maintains, communicates and applies all bulletins, newsletters, and correspondence to current processes after PFS Management approval.

1. Other –

• Keeps abreast of all PFS follow up processes and procedures to ensure accuracy of payment.
• Maintains knowledge of all industry follow up changes and incorporates those into process after PFS Management approval.
• Completes special projects and requests as assigned by the PFS Management, or Sr system analyst based on deadlines given.
• Performs all other duties as assigned by PFS Management or Sr system analyst.

• Knowledge of medical billing / collection practices required
• Strong keyboard skills.
• Knowledgeable of Excel
• Ability to multi-task
• Strong communication skills written and verbal
• Works well in environment with firm deadlines; results oriented.
• Perform multiple tasks effectively.
• Able to work both independently and as part of a team.
• Strong analytical skills required.
• Capable of making timely, independent decisions.
• Meeting required Productivity (5 accounts an hour)

• Previous medical hospital collections experience including knowledge of coordination of benefits
• 3 - 5 years' experience in healthcare billing & collection practices.
• Experience working with medical payers including Blue, Commercial insurance, & Workers Compensation.
• Working knowledge of medical billing systems.
• Experience with payer Electronic Eligibility Responses
• Working knowledge of CPT and ICD-10 coding systems; Medical terminology
• Excellent Organizational skills
• Proficiency in Microsoft Office Suite & Excel

• Requires full range of body motion including manual finger dexterity and eye-­ hand coordination.
• Able to lift 25 pounds