Job Details

Position Overview : Reporting to the Hospital Collections Supervisor, the Level III - High Dollar Collector is responsible for the follow-up and resolution of high-balance Insurance accounts. This role requires extensive knowledge of insurance payers, appeals processes, clinical policies and medical billing practices. The ideal candidate will be detail-oriented, proactive, and skilled in resolving complex account issues to ensure timely and accurate reimbursement.

Responsibilities:

• Completes in-depth reviews and timely follow ups on high-dollar accounts (typically $10,000 and above) to ensure claim resolution to obtain maximum reimbursement.

• Identifies trends or issues causing delays or denials, escalating to all appropriate parties.

• Must write targeted appeals and reconsiderations for denied or underpaid claims.

• Reviews medical records, summary plan documents, and contracts to determine if we have cause for medical necessity.

• Leverages knowledge of all payers BCBS, Aetna, UHC, Cigna, Commercial, and Managed Medicare.

• Reviews insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents.

• Extensive knowledge of Fee Schedules and Payor Contracts

• Works closely with cross functional departments such as billing, coding, and payment posting to resolve account discrepancies.

• Facilitate effective communication with insurance carriers, patients, and internal departments to resolve outstanding balances

• Works a minimum of 30 accounts daily with > or = 90% accuracy rating; must meet department productivity standards.

Required Skills:

Required Skills

• 5-10 Years Surgical Hospital or Acute Care Hospital experience

• Strong knowledge of commercial and government payers (Medicare, Medicaid, BCBS, UHC, etc.).

• Must demonstrate a positive demeanor, excellent verbal and written communication skills, and must exhibit professionalism.

• Must be able to handle potentially high stress situations and handle competing priorities while meeting or exceeding deadlines.

• Maintains appropriate account-level reviews to ensure timely account processing.

• Experience with Cerner and Nthrive required. Additional payer portal experience is a plus.

• Must have Intermediate computer proficiency in Microsoft Office, including Excel and Outlook.

• Strong mathematical skills, research, analysis, decision making, and problem-solving skills.

• Demonstrates excellent problem-solving skills and negotiating skills.

• Strong understanding of medical terminology and CPT/ICD-10 coding

• Personal qualities of integrity, credibility, accountability, and commitment to the organization; displays a proactive, hands-on approach partnering with stakeholders to enhance overall value and visibility of the organization.

• High school graduate or equivalent