Hospital A/R Collector

United Surgical Partners International; Dallas (TX); In loco; USD 52.000 - 78.000; Tempo pieno

Descrizione del lavoro

United Surgical Partners International is seeking a Collector to manage hospital accounts receivable, focusing on surgical claims, denials, and appeals. You will coordinate with payers to secure maximum reimbursement and review complex medical documentation for medical necessity.

This role requires strong communication, time management, and proficiency with multiple health payer systems. On-site Dallas environment with focus on accuracy and efficient follow-up.

Competenze

• 3+ years hospital collections experience preferred.
• Excellent communication and interpersonal skills.
• Strong time management and prioritization.
• Excellent customer service and professionalism.
• Ability to read insurance explanations of benefits and contracts.
• Experience with multiple health care payers preferred.
• Proficient in Microsoft Office including Excel and Outlook.

Mansioni

• Follow up on outstanding A/R to maximize reimbursement for all payers.
• Manage daily work queues and prioritize high-dollar balances.
• Perform insurance follow-ups for denials and appeals; verify eligibility.
• Review payer contracts and ensure correct claim processing.
• Review patient balances and collect payments; review insurance payments for accuracy.
• Negotiate payments with third-party administrators for out-of-network procedures.
• Prepare documentation for medical necessity and appeals when needed.

Conoscenze

Hospital collections

Excel

Outlook

DDE

Ability Ease

nThrive

Cerner

Advantx

Vision

HST

Waystar

Formazione

High School Diploma or equivalent

Strumenti

DDE

Ability Ease

nThrive

Cerner

Advantx

Vision

HST

Waystar

Descrizione del lavoro

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 insuranceclaimfollow-ups for insurancedenialsand 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.