Medical Collection Specialist (Advanced Level)

Muscogee Nation Business Enterprises; San Antonio (TX); On-site; USD 45,000 - 65,000; Full time

Job summary

Muscogee Nation Business Enterprises in San Antonio, TX seeks an advanced Medical Collection Specialist to manage patient accounts, pursue payments, and resolve billing discrepancies in coordination with insurers.

The role requires CPB or CBCS certification or an associate degree with 3 years’ medical billing experience, strong communication, empathy, and the ability to work under pressure.

Qualifications

• CPB or CBCS certification is required or preferred.
• Associate degree in medical billing/coding with at least 3 years of private-sector billing experience.
• Experience with multiple health insurers (Medicare/Medicaid) and medical billing/collections.

Responsibilities

• Manages and follows up on assigned queues for denials and billing errors per BAMC guidelines.
• Pursues appeals and takes steps to bring accounts to resolution.
• Analyzes accounts for errors, adjustments and credits; issues corrected entries when needed.
• Investigates unusual issues affecting payment delays; escalates as required.
• Reviews payments per payer EOB and submits timely appeals when total charges are not received.
• Identifies billing/posting errors using EOB; corrects within 48 hours.
• Identifies denial trends and reports findings with recommended actions to prevent future denials.
• Extracts patient treatment information from medical records to support individualized appeal letters.
• Performs duties of Medical Billing Specialist during staffing shortages or high workload as directed.

Education

Certified Professional Biller (CPB)

Certified Billing and Coding Specialist (CBCS)

Associate degree in medical billing/coding

Job description

Job Description

Overview

OverviewAn advanced level Medical Collection Specialist is responsible for managing and pursuing outstanding patient accounts to secure payment for medical services rendered. This role involves contacting patients and insurance companies to resolve billing discrepancies and escalating delinquent accounts when necessary. The specialist must possess a deep understanding of medical billing and collections processes to include appeals, as well as knowledge of relevant laws and regulations governing debt collection in the healthcare sector. Strong communication skills, empathy, and the ability to work effectively under pressure are key attributes for success in this position.

Duties

• Dutiesa) Manages and works assigned queues for follow-up, denials and billing errors of medical claims within BAMCs guidelines. b) Pursues appeals and takes the necessary steps to bring accounts to resolution. c) Analyzes accounts for errors, adjustments and credits, issuing corrected entries when necessary. Updates account information accordingly. d) Investigates accounts to identify any unusual issues affecting payment delays. e) Reviews payments received in accordance with benefits quoted by the payer's Explanation of Benefits (EOB). Submits a timely appeal to the payer for instances where total charges are not received. f) Identifies billing errors and/or posting errors utilizing the EOB. Corrects billing and posting errors within 48 hours. Identify complex dispute issues to the site supervisor and/or manager for review. g) Processes remaining balances that are uncollectable per guidance in the billing system with the appropriate codes. h) Analyze and identify denial trends and presents findings with recommended course of action to the site supervisor and/or manager to prevent future denials and further delay in payments. i) Extracts information regarding patient treatment from medical records and works closely with coding staff to compose individualized appeal letters. j) Shall perform the task requirements of the Medical Billing Specialist during time of low staffing or increase workload demands at the direction of the government representative and/or contract manager.

Requirements

• Requirementsa. Current and up to date Certified Professional Biller (CPB) –or b. Certified Billing and Coding Specialist (CBCS) –or c. Possess an associate college degree in medical billing/coding and have a minimum of 3 years of experience, within the past 5 years, in private sector (non-DOD or VA). Experience must include working with a variety of health insurance companies, Medicare/Medicaid, as well as medical billing and collections. Certifications must be kept up to date and continued throughout the job.