Hospital A/R Collector

United Surgical Partners International, Inc; Dallas (TX); On-site; USD 52,000 - 65,000; Full time

Job summary

United Surgical Partners International, Inc. is seeking a Hospital Collections Collector in Dallas, TX to resolve outstanding surgical claims and maximize reimbursement. You will follow up on high-dollar A/R, manage work queues, handle denials and appeals, and review payer contracts to ensure proper processing.

The role requires 3+ years in hospital collections, excellent communication, and proficiency with Excel/Outlook. Experience with DDE, nThrive, Cerner, and Waystar is preferred.

Qualifications

• 3+ years hospital collections experience preferred.
• Excellent communication skills and interpersonal skills.
• Skilled in time management and prioritization of emergent situations.
• Excellent customer service skills, demonstrating professionalism.
• Ability to read and interpret insurance explanations of benefits and managed care contracts.

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 queues to prioritize high dollar claim balances.
• Perform insurance claim follow-ups for insurance denials and appeals; Contact insurance companies to check eligibility and benefits via phone or online.
• Reviewing payer contracts to ensure claims have processed correctly.
• Knowledge of all payers MCR, MCR ADVG, Medicaid, Medicare Advantage, and Commercial payers.
• Review & work incoming insurance and patient correspondence including refund requests.
• Prepare and write medical necessity 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.
• 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 for claim resolution.
• Negotiate payment amounts for procedures with Third Party Administrators for out of network providers.
• Recommend an adjustment when applicable or a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.

Skills

Hospital collections

Communication skills

Time management

Customer service

Insurance explanations of benefits

Education

High School Diploma or equivalent

Tools

DDE

Ability Ease

nThrive

Cerner

Advantx

Vision

HST

Waystar

Job description

Reporting to the Hospital Collections Supervisor, the 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 for resolving outstanding surgical claims resulting in maximum reimbursement.

• 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 queues to prioritize high dollar claim balances.
• Perform insurance claim follow-ups for insurance denials and appeals; Contact insurance companies to check eligibility and benefits via phone or online.
• Reviewing payer contracts to ensure claims have processed correctly.
• Knowledge of all payers MCR, MCR ADVG, Medicaid, Medicare Advantage, and Commercial payers.
• Review & work incoming insurance and patient correspondence including refund requests.
• Prepare and Write Medical Necessity 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.
• 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:

• 3+ years of hospital collections experience preferred.
• Excellent communication skills and interpersonal skills
• Skilled in time management and prioritization of emergent situations.
• Excellent customer service skills, demonstrating professionalism.
• Ability to read and interpret insurance explanations of benefits and managed care contracts.
• Knowledge or experience working with a variety of health care insurance payers is preferred.
• Intermediate computer proficiency in Microsoft Office including Excel and Outlook.
• DDE, Ability Ease, nThrive, Cerner, Advantx, Vision, HST, Waystar experience preferred.
• High School Diploma or equivalent.