A/R Specialist, Collector

United Surgical Partners International, Inc; United States; On-site; USD 45,000 - 65,000; Full time

Job summary

United Surgical Partners International, Inc. is seeking an A/R Specialist-Collector to optimize surgical claim reimbursements. You will handle denial processing, appeals, EOB review, and patient billing inquiries in a fast-paced ASC setting.

Experience in ASC revenue cycle or orthopedic collections is required; strong communication and multi-tasking skills are essential. Proficiency in Excel/Outlook and payer contracts is preferred; on-site role.

Qualifications

• 2+ years of ASC revenue cycle OR orthopedic collections experience.
• Ability to read and interpret insurance explanations of benefits and managed care contracts.
• Must communicate effectively, both verbally and in writing, with internal and external clients.
• Must be able to multi-task and handle competing priorities while meeting or exceeding deadlines
• Knowledge or experience working with a variety of health care insurance payers is preferred
• Intermediate computer proficiency in Microsoft Office including Excel and Outlook
• Advantx, Vision, HST, Waystar experience preferred.
• High School Diploma or equivalent.

Responsibilities

• Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers including self-pay to obtain maximum reimbursement.
• Manage daily work queue to prioritize high dollar claim balances.
• Review & work incoming insurance and patient correspondence including refund requests.
• Send appeals when appropriate or provide the requested medical documentation.
• Ability to review medical documentation to justify medical necessity.
• Review patient balances to ensure accuracy and follow up with patients to obtain payments.
• Take incoming patient phone calls to resolve inquiries, billing issues, or outstanding balances.
• Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents.
• Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD’s) for claim resolution.
• Negotiate payment amounts for procedures with Third Party Administrators for out of network providers.
• Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.

Skills

ASC revenue cycle

Orthopedic collections

Communication

Multitasking

Excel & Outlook

Education

High School Diploma

Tools

Microsoft Excel

Microsoft Outlook

Advantx

Vision

HST

Waystar

Job description

Position Overview

Reporting to the Client Operations Manager, the A/R Specialist- Collector must have a strong knowledge of medical collections, accounts receivables, insurance billing and verification, denial processing, appeal submission and EOB review. This position is responsible to resolve outstanding surgical claims resulting in maximum reimbursement.

Position Overview

Reporting to the Client Operations Manager, the A/R Specialist- Collector must have a strong knowledge of medical collections, accounts receivables, insurance billing and verification, denial processing, appeal submission and EOB review. This position is responsible to resolve outstanding surgical claims resulting in maximum reimbursement.

Responsibilities

• Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers including self-pay to obtain maximum reimbursement.
• Manage daily work queue to prioritize high dollar claim balances.
• Review & work incoming insurance and patient correspondence including refund requests.
• Send appeals when appropriate or provide the requested medical documentation.
• Ability to review medical documentation to justify medical necessity.
• Review patient balances to ensure accuracy and follow up with patients to obtain payments.
• Take incoming patient phone calls to resolve inquiries, billing issues, or outstanding balances.
• Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents.
• Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD’s) for claim resolution.
• Negotiate payment amounts for procedures with Third Party Administrators for out of network providers.
• Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.

Required Skills

Requirements

• 2+ years of ASC revenue cycle OR orthopedic collections experience.
• Ability to read and interpret insurance explanations of benefits and managed care contracts.
• Must communicate effectively, both verbally and in writing, with internal and external clients.
• Must be able to multi-task and handle competing priorities while meeting or exceeding deadlines
• Knowledge or experience working with a variety of health care insurance payers is preferred
• Intermediate computer proficiency in Microsoft Office including Excel and Outlook
• Advantx, Vision, HST, Waystar experience preferred.
• High School Diploma or equivalent.