Medical Insurance Collections Specialist

BERAJA MEDICAL INSTITUTE; Sunrise Harbor (FL); On-site; USD 40,000 - 60,000; Full time

Benefits offered by this job

Health Insurance

Dental Insurance

Vision Insurance

Paid Time Off (PTO)

Employee Assistance Program

Job summary

BERAJA MEDICAL INSTITUTE in Sunrise Harbor, Florida is looking for a Medical Insurance Collections Specialist to handle the resolution and collection of problematic insurance claims. The role requires strong knowledge of medical billing and the ability to communicate effectively with insurance carriers.

The ideal candidate will possess previous experience in medical billing, excellent interpersonal skills, and a working knowledge of billing guidelines, ensuring all processes adhere to industry standards. A competitive benefits package is provided.

Qualifications

• Graduation from accredited high school or equivalent.
• Associates degree in related field of study.
• Medical Billing and Program Diploma.
• More than 2 years in Medical Billing and Collections experience.
• Experience with Medicare and Medicaid billing guidelines.
• Understanding of managed care contracts.

Responsibilities

• Resolve and collect problematic and aged insurance claims.
• Contact insurance carriers for claim status updates.
• Prepare and submit appeals when necessary.
• Work as a team member within the department.
• Document work processes as required.

Skills

Knowledge of Billing Guidelines and ICD-10, CPT and HCPCS coding

Strong interpersonal and communication skills

Organizational problem solving and analytical skills

Computer proficiency in Word, Excel, and Outlook

Bilingual English and Spanish

Education

Graduation from accredited high school or equivalent

Associates degree in related field of study

Medical Billing and Program Diploma

Tools

Medical billing systems

Job description

Medical Insurance Collections Specialist

Beraja Medical Institute has been serving the South Florida community for 30 years and we are committed to providing our patients with the latest and most advanced procedures and equipment available to treat all eye diseases

The surgical results and the satisfaction of our thousands of patients have made us one of the leaders in the field of eye care in South Florida.

Medical Insurance Collections Specialist is responsible for the resolution and collection of problematic and aged insurance claims on behalf of clients. The daily functions include contacting insurance carriers for claim status updates, resubmission of claims, prepare and submit appeals when necessary, etc. Additional responsibilities include routine follow‑up on rejections and denials, communicating with insurance carriers/third parties.

Essential Functions

• Ability to process rejections and denials to determine if a claim needs to be refilled or submitted and appealed with the carrier
• Ability to meet minimum daily and monthly productivity performance metrics
• Validate all carrier appeal request
• Ability to handle complex calls; identifying the problem and escalating issues as needed.
• Work accounts based on aging report within the practice management systems
• Determines most effective means of collection for each account, applies standard due diligence practice to collect monies owed, composes correspondence requiring knowledge of procedure and practices in collections and also sends a variety of standard collection letters
• Compiles information and prepares a variety of reports on collection activities for manager, such as outstanding and current account standings

Additional Responsibilities

• Ability to adhere to policy and procedures set company wide and interdepartmentally
• Strong interpersonal and communication skills with an ability to work effectively with a wide range of people, teams, managers, supervisors, and third party payers
• Attends department meetings and training seminars to obtain information and department updates.
• Ability to make sound and evaluative judgments; strong organizational problem solving and analytical skills
• Maintain professional appearance and personal conduct at all times
• Work as a team member within the department
• Document work processes as required
• Perform other duties as assigned

Core Competencies

• Knowledge of Billing Guidelines and ICD-10, CPT and HCPCS coding.
• Ethical Conduct.
• Leadership.
• Thoroughness.
• Time Management.
• Confidentiality.

Required Education and Experience

• Graduation from accredited high school or equivalent.
• Associates degree in related field of study.
• Medical Billing and Program Diploma.
• More than 2 years in Medical Billing and Collections experience.
• Experience with Medicare and Medicaid billing guidelines and rules, insurance reimbursement methods, the claims appeal process.
• Understanding of managed care contracts and capitation payments.
• Experience with billing and collections of physician commercial insurances.
• Computer proficiency in Word, Excel, Outlook, along with general knowledge of internet research and medical billing systems.

Preferred Education and Experience

Certified Professional Biller Certificate (CPB) Preferred

Bilingual English and Spanish

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

BENEFITS PACKAGE

Health Insurance, Dental Insurance, Vision Insurance and Paid Time Off (PTO), Employee Assistance Program

Relocation Assistance Available

We are a drug‑free workplace

All your information will be kept confidential according to EEO guidelines.

AAP/EEO Statement

We are an Equal opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for their job. Duties, responsibilities, and activities may change at any time with or without notice.