Medical Collections Specialist (BCBS)

Midwest Orthopaedics at RUSH; Westchester (IL); On-site; USD 30,000 - 33,000; Full time

Benefits offered by this job

Quarterly Bonus Incentives

Medical Insurance

Dental Insurance

Vision Insurance

Paid Time Off

401(k) Plan

Life Insurance

Long-term Disability

HSA/FSA available

Tuition Reimbursement

Job summary

Midwest Orthopaedics at Rush is seeking a full-time Collections Specialist to manage insurance claims, patient accounts, and denial resolution for orthopedics patients. Remote work is available with occasional trips to the Westchester, IL office for training and meetings.

Candidates should have BCBS payor expertise and solid revenue-cycle experience in a medical setting. You will analyze authorizations and denials, coordinate with payors and patients, and document all activities in the system

Qualifications

• High School Diploma or equivalent; Associates or Bachelor’s Degree preferred.
• 3-4 years of related experience in a business office or revenue cycle.
• Expertise in government, commercial and/or third party payor claims submission, denial resolution, and appeals processes.
• Experience with patient accounting systems; Athena preferred.
• Medical terminology; CPT/HCPCS/ICD coding knowledge.

Responsibilities

• Analyze authorizations, claims, EOBs and identify next actions toward payment.
• Follow payor guidelines to ensure timely follow-up on balances.
• Perform appeals and disputes per payor guidelines; track outcomes.
• Contact patients or payor reps to resolve claims and coordinate benefits.
• Identify denial trends with management and report findings.
• Research payor requirements and collaborate with Coding Team to resolve denials.
• Document all follow-up activities in the practice management system.
• Meet productivity and quality standards; ensure compliance with MOR policies.

Skills

BCBS payor expertise

Claims processing

Denial resolution

Revenue cycle knowledge

Documentation skills

Education

High School Diploma

Associates or Bachelor's preferred

Tools

Athena

Job description

It’s the people that make the difference. Are you ready to make your impact?

Midwest Orthopaedics at Rush, with locations in Chicago and the Western Suburbs, is nationally recognized as a leader in comprehensive orthopedic services. The physicians of Midwest Orthopaedics at Rush have received specialized training in orthopedic surgery and in subspecialty areas within the field of orthopedic medicine and can diagnose and treat even the most complicated and rare musculoskeletal conditions. The Orthopedic Program at Rush University Medical Center is ranked Top 10 in the nation by U.S. News and World Report. Midwest Orthopaedics at Rush doctors are the official team physicians for the Chicago White Sox, Chicago Bulls, Chicago Fire Soccer Club and DePaul University Athletics.

Ready to join? We are seeking a full-time Collections Specialist to join our team. In this role you will be responsible for processing insurance claims, managing patient accounts, resolving unpaid or rejected claims for orthopedics patients, resolving overpaid claims,capturing and investigating denial trends and collaborating with the team lead and/or management to help resolve the challenging claims . You will maintain accurate claim and account information, respond to account inquiries from both the patient and the practice,and document all patient interactions. We are looking for a candidate with expertise in BCBS payor. This position offers the opportunity to work remotely. Candidate must be flexible to travel to the corporate office in Westchester, IL for training and as needed for team meetings.

Essential Duties and Responsibilities

include the following. Other duties may be assigned.

• Analyzes authorizations, claims, explanation of benefits, correspondence, payor website and/or any additional information necessary to identify the next appropriate action toward payment resolution.

Follows commercial payor guidelines to ensure complete and timely follow-up on open balances for assigned payors or accounts in a timely manner.

Performs appeals, underpayment appeals, and disputes by following commercial, payor appeals guidelines or contracted terms. Utilizes payor contracts and fee schedules to perform underpayment appeals or collaborates with the practice to obtain medical necessity appeals documentation. Assists with tracking appeals outcomes.

• Contacts patients or appropriate payor representatives via phone or electronically to resolve claims and/or coordinate benefits and submits claim in the correct filing order. Works to identify other payors when possible and ensures all payors and filing order is correct in the practice management system.

Collaborates with the team lead to identify patterns and interpret denial trends. Notifies Manager when insurance plans deny services, which are covered based on the contract terms, government regulations, third party agreement or patient’s benefit plan.

• Works to minimize write-offs by exhausting all resolution options and performing thorough research/review of all appropriate resources. Adjusts account or requests write- offs adhering to MOR policies and procedures.
• Reviews denial reports and makes recommendations for billing or claim submission changes based on claim denials.
• Research payor and government websites and/or medical resources, to identify payor claim requirements required to resolve open accounts receivable.
• Collaborates with Coding Team or physician to resolve coding related denials and submits all coding related corrected claims and/or appeals.
• Targets and reports any internal procedures or processes that may negatively impact or increase days in accounts receivable or delay claims resolution.

Interact with patients and commercial payors to respond to billing requests as appropriate.

• Assists call center representatives with physician practice or patient requests by providing claim information and/or claim status to call center representative to correctly respond to patients
• Meets productivity and quality standards.
• Documents using standardized note format all payor, attorney, and/or third party follow-up and account resolution activities in the practice management system
• Remains current with trends, regulatory requirements, and business strategies related to the revenue cycle
• Operates in compliance with all local, state and Federal laws as well as Company policy and compliance standards
• Other duties and responsibilities as assigned

Education and/or Experience

• High School Diploma or equivalent; Associates or Bachelor’s Degree preferred

3-4 years of related experience in a business office or on a revenue cycle team; Preference given for physician or medical group CMS 1500 experience

• Expertise in government, commercial and/or third party payor claims submission, denial resolution, and appeals processes
• Experienced with patient accounting systems – Athena preferred
• Medical terminology required for accurate claims processing
• Knowledge of CPT, HCPCS, and ICD coding systems

What’s in it for you?

MOR offers their employees a comprehensive compensation and benefits package.

Pay Range: $22.00 - $24.00 per hour.

Compensation at MOR is determined by many factors, which may include but are not limited to, job-related skills and level of experience, education, certifications, geographic location, market data and internal equity. Base pay is only a portion of the total rewards package.

• Quarterly Bonus Incentives
• Medical, Dental and Vision Insurance.
• Paid Time Off and Paid Holidays.
• Company-paid life and long-term disability insurance.
• Voluntary life, AD&D, and short-term disability insurance.
• Critical Illness and Accident Insurance.
• 401(k) Savings Plan.
• 401(k) Employer Contribution.
• Pet Insurance.
• Employee Assistance Program (EAP).
• Tax-Advantaged Accounts (FSA, HSA, Dependent Care FSA).
• HSA Employer Contribution (when enrolled in a HDHP).
• Tuition Reimbursement.
• Continuing Education of up to $2,500 annualized.
• Excellent working relationship with prestigious group of physicians in Orthopedics in the US and #1 in Illinois and Indiana.

Our employees make the difference in our patients’ lives, and we value their contributions. Midwest Orthopaedics at Rush offers a comprehensive compensation and benefits package and an opportunity to grow and develop your career with an industry leader. Come see what we’re all about.

Equal Opportunity Employer.

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.