Collection Specialist, Full Time

Hialeah Hospital; Florida; On-site; USD 36,000 - 54,000; Full time

Job summary

Hialeah Hospital is seeking an experienced patient accounts specialist to perform insurance follow-up, review credit balances, and resolve discrepancies, under the supervision of the VP of Revenue Cycle. You will contact carriers, resubmit claims with proper remarks, and ensure timely resolution of refunds and audits, contributing to accurate hospital accounts receivable.

Candidates should have at least one year of commercial, HMO, PPO, and workers' compensation billing experience and a high

Qualifications

• Minimum 1 year Commercial, HMO, PPO, and Workers' Compensation billing experience.
• Experience with insurance follow-up workflows and payer communications.
• Familiarity with managed care contracts language and interpretation.

Responsibilities

• Follow up with Insurance carriers on outstanding balances until resolved.
• Resubmit claims with proper remarks and attachments as needed.
• File insurance reconsideration letters for payment or denial disputes.
• Validate accounts for accurate payments, discounts, and contractual adjustments.
• Reply to insurance carrier correspondence as appropriate.
• Run insurance eligibility checks and correct claims before resubmission.

Skills

Insurance follow-up

Claims resubmission

Carrier communications

Credit balance review

Regulatory knowledge

Education

High School diploma or equivalent

Job description

Job Objective:

Under the supervision of the Vice President of Revenue Cycle or designee, performs patient account follow-up, credit balance review and resolution, keeping the hospital's accounts receivable as accurate as possible.

Duties and Responsibilities:

• Insurance follow-up, as assigned.
• Contact insurance carriers regarding outstanding balances until resolution.
• Resubmit claims with the appropriate remarks and/or attachments as needed.
• File insurance reconsideration letter for payment and/or denial disputes.
• Validate accounts for accurate payments, discounts, and contractual adjustments.
• Reply to insurance carrier correspondence as appropriate.
• Run insurance eligibility and correct claim before resubmission as needed.
• Pull supporting documents for annual regulatory audits, as needed.
• Ensure credit balance and refund requests are reviewed and resolved timely.
• Answer in-coming calls resolving patient and/or insurance issues timely.
• Assist with other duties as assigned, within skill sets and abilities.

Education

High School graduate or equivalent

Experience

Minimum 1-year Commercial, HMO, PPO, and Workers Compensation billing and/or

Insurance follow-up experience.

Working knowledge of HMO, PPO, Commercial, and Workers' Compensation reimbursement.

Working knowledge of Managed Care contract language and interpretation.

What Should I Know About Hialeah Hospital?

Our 378-bed acute care hospital opened in 1951 to serve the Hialeah, Florida community. Our team is committed to honoring the trust that our patients place in us by providing compassionate, safe, high-quality care in the right place, and at the right time.

Cardiac

American Heart Association Get with the Guidelines - Heart Failure Gold Plus Award, 2018

American Heart Association Get with the Guidelines - Target Stroke Gold Plus Award, 2018

Bariatric

American College of Surgeons/American Society for Metabolic and Bariatric Surgery - MBSAQIP Accredited Center

BCBS - Blue Distinction Specialty Care Bariatric Surgery, January 2018

Neurology

Advanced Primary Stroke Center Re-accreditation, April 2018

Women's Services

American College of Radiology granted Stereotactic Breast Biopsy Re-accreditation, March 2016

Hyperbaric Unit

Healogics Center of Distinction Award, 2017

Laboratory Services/Blood Bank

Certificate of Accreditation from College of American Pathologist