Medical Billing & Collections Specialist

The Opportunity: Your Focus

We are seeking a highly analytical and experienced Patient Financial Services Representative to manage the full revenue cycle, specifically focusing on complex claims, detailed billing, and account collections. You will be the expert who resolves challenging account discrepancies and secures necessary payments, balancing financial goals with empathetic customer service.

Key Responsibilities:

1. Detailed Billing and Claims Processing

• Claim Review and Submission: Review, correct, and submit complex medical claims to various commercial and governmental payers (e.g., Medicare, Medicaid) using correct CPT, ICD-10, and HCPCS codes.
• Denial Management: Investigate and appeal denied claims, identifying root causes (e.g., incorrect codes, lack of prior authorization) and reprocessing claims accurately for maximum reimbursement.
• Payer Relations: Communicate effectively with insurance companies to resolve discrepancies, verify payments, and understand current reimbursement policies.

2. Collections and Account Resolution

• Debt Collection: Handle outbound and inbound calls related to past-due patient balances and unpaid claims, negotiating payment arrangements and clearly explaining financial responsibilities.
• Payment Plans: Set up and manage patient payment plans, ensuring adherence to established financial policies while providing compassionate service.
• Credit Balances: Identify and process patient and payer credit balances for accurate refund distribution.

3. Compliance and System Management

• Compliance: Strictly adhere to all industry regulations, including HIPAA, Fair Debt Collection Practices Act (FDCPA), and internal compliance standards.
• System Integrity: Maintain accurate and detailed documentation of all billing activities, collection efforts, payment arrangements, and correspondence within the EHR/Billing System (e.g., Epic, Cerner).
• Reporting: Track and report on key financial performance indicators such as Accounts Receivable (AR) days and collection rates.