Denials Management Medical Collector - PB (Hybrid)

The Collector is responsible for Collections and Denial Management ensuring the appropriate action is taken on assigned accounts in a timely manner resulting in positive resolution.

Your Everyday

• Maintains responsibility for accurate and timely completion of daily follow-up or denial account assignment

• Identifies and analyzes underpayments to identify reasons for discrepancies and process denials and appeals as needed
• Reviews posted payments and adjustments to ensure accuracy. Analyzes EOBs to ensure proper reimbursement
• Conducts relevant research to complete appeals process to include assessing, complete and accurate documentation, tracking, responding to, and / or resolving appeals with third party payers in a timely manner
• Communicates with payers on outstanding claims, resolves payment variances and achieves timely reimbursement
• Accurately documents all activity on the patient account
• Collaborates with internal departments and external organizations to ensure correct reimbursement and resolve appeals
• Monitors underpaid and denied claims for trends and to identify root causes and reports findings to supervisor
• Demonstrates initiative and resourcefulness by making recommendations and communicating trends and issues to management
• Observes best practice processes in follow-up and customer service activities
• Participates in staff training that aligns with recognized improvement opportunities and increase understanding of Medicare/Medicaid requirements as well as general follow-up processes
• Acts in accordance with LCMC’s mission and values, while serving as a role model for ethical behavior
• Adheres to federal and state regulations related to the protection of patient information (e.g., the Health Insurance Portability and Accountability Act (HIPAA) as well as facility-specific guidelines

The Must-Haves

EXPERIENCE QUALIFICATIONS

• Minimum two years of experience in a healthcare environment, particularly in healthcare billing, collections, payment processing, or denial management is preferred

EDUCATION QUALIFICATIONS

• Required: A high school diploma or GED

SKILLS AND ABILITIES

• Must be able to pass basic computer skills test and system level training
• Working knowledge of system reports and the ability to analyze system information to determine the impact of possible changes
• Demonstrates knowledge of:
  Hospital and professional billing processes and reimbursement
  Third-party contracting
  Insurance protocols, delay tactics, systems, and workflows
  ERISA guidelines for denials and appeals
  Regulations related to denials and appeals
• Ability to take initiative by identifying problems, conceptualizing resolutions, and implementing change
• Possesses efficient time-management skills and proven ability to multitask under tight deadlines
• Demonstrates excellent customer service skills
• Effective writing and communication skills
• Strong comfort level with computer systems