Insurance Collection Spec

Gastro Health; Miami (FL); On-site; USD 42,000 - 62,000; Full time

Job summary

Gastro Health is seeking an Insurance Collections Specialist to manage the reimbursement process, follow up on outstanding balances, and negotiate payment arrangements. You will review claims, analyze accounts, and maintain positive relationships with insurance providers to support the organization’s financial health.

The role requires attention to detail, knowledge of billing practices (CPT/ICD-10), and the ability to communicate effectively with payers, providers, and patients.

Qualifications

• 4+ years of experience in insurance collections.
• Experience with HMO, PPO, and Medicare insurances.
• Bilingual Spanish/English with the ability to compose correspondence in both languages.

Responsibilities

• Liaison between providers, patients, and payers to ensure accurate charges and account resolution.
• Maintains active communications with insurance carriers until paid.
• Negotiates payment of current and past due accounts by phone and written communication.
• Updates patient account information and monitors payer denial trends.
• Runs aging reports and manages buckets for assigned insurances.

Skills

Insurance collections

Spanish/English bilingual

Medical terminology

Phone customer service

Education

High school diploma

Job description

About Gastro Health:

Gastro Health is an extensive and diverse group of professionals dedicated to digestive and liver health. Now with more than 120 locations in seven states, our team of physicians, advanced practice providers, nutritionists, technicians, and support team are on a mission to provide outstanding medical care and an exceptional healthcare experience.

Position Summary:

As an Insurance Collections Specialist at Gastro Health, your role is crucial in managing the reimbursement process and ensuring timely payment from insurance companies. You will review and analyze insurance claims, follow up on outstanding balances, and negotiate payment agreements. Your attention to detail, knowledge of insurance billing practices, and persistence in resolving payment issues contribute to the financial success of Gastro Health and maintain positive relationships with insurance providers.

Essential Functions include but are not limited to the following:

• Liaison between the providers of health care services, the patient, or other responsible persons, and revenue sources, to ensure the correctness of charges, a current record of all transactions, and account resolution.
• Maintains active communications with insurance carriers and third-party carriers until the account is paid.
• Negotiates payment of current and past due accounts by direct telephone and written correspondence.
• Updates patient account information.
• Monitors and identifies payer denial trends and problem accounts; communicates patterns to supervisor.
• Process assigned accounts refunds and overpayments as per the company’s policies and procedures.
• Runs a monthly aging report based on DOS and current A/R to identify accounts that require follow-up.
• Manage all MGR buckets on a daily basis for assigned insurances.
• Utilize collection techniques to resolve accounts according to the company’s policies and procedures.
• Report any coding-related denial to the Coding Specialist.
• Performs other duties including but limited to faxing information as required, generating retroactive authorization requests, and verifying medical eligibility.
• Conducts necessary research to ensure proper reimbursement of claims.
• Assist with special projects assigned by Billing Manager or Supervisor.

Job Specifications/Qualifications

• High school diploma or GED equivalent
• 4+ years of experience in insurance collections
• Experience with HMO, PPO, and Medicare insurances

Required Skills And Abilities

• Knowledge of medical terminology utilized in medical collections and billing (CPT, ICD-10, HCPCS) and letters of appeal.
• Experience with HMO, PPO, and Medicare insurances.
• Bilingual Spanish/English with the ability to compose correspondence with both languages.
• Experience in phone customer service is a plus.

Why You'll Thrive at Gastro Health

We look for team members who embody our values of Compassion, Collaboration, Integrity, Accountability, Empowerment, Continuous Improvement, Positive Attitude, and Customer Focus. These values guide how we care for our patients, support one another, and deliver exceptional healthcare every day.

Physical Requirements And Working Conditions

• Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions of the position.
• Primarily performed in an office environment with moderate noise levels.
• Frequent sitting, standing, walking, bending, reaching, computer use, and communication.
• Occasional lifting up to 10 lbs., pushing/pulling, and climbing stairs.
• Frequent interaction with staff, managers, patients, families/caregivers, providers, vendors, and other business partners.
• May require occasional weekends, holidays, or varying shifts based on business needs.

Communication Requirements

• Ability to effectively read, write, speak, and understand English to safely perform the essential functions of the position.

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.