AR Specialist Collector

United Surgical Partners International Inc (USPI); United States; On-site; USD 40,000 - 60,000; Full time

Job summary

United Surgical Partners International Inc (USPI) is hiring a Revenue Cycle Specialist - Collector to manage medical collections and ensure optimal reimbursement from payers. The ideal candidate will have over 2 years of experience in revenue cycle management or orthopedic collections.

This position involves timely follow-up on outstanding accounts, reviewing insurance payments, and negotiating claims. Effective communication skills and knowledge of various health care insurance payers are essential. The company offers a supportive work environment with growth opportunities.

Qualifications

• 2+ years of ASC revenue cycle or orthopedic collections experience.
• Skill in interpreting insurance explanations of benefits.
• Ability to multi-task and handle competing priorities.

Responsibilities

• Follow up on all outstanding accounts receivables for maximum reimbursement.
• Manage daily work queue for high dollar claim balances.
• Review incoming insurance and patient correspondence.

Skills

Medical collections knowledge

Accounts receivables

Insurance billing and verification

Denial processing

Effective communication

Education

High School Diploma or equivalent

Tools

Microsoft Excel

Microsoft Outlook

Advantx

Vision

HST

Waystar

Job description

Position Overview

Reporting to the Client Operations Manager, the Revenue Cycle 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.

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.