PFS Collection Specialist

Confluent Health LLC; New York (NY); Remote; USD 40,000 - 55,000; Full time

Job summary

Confluent Health, LLC is seeking a Remote Medical Billing Collections Specialist to manage patient and payer balances according to revenue cycle policies. You will monitor accounts, follow up on claims and denials, and ensure accurate reimbursement for services provided.

A high school diploma or GED, basic Windows computer skills, and strong communication are required. The role emphasizes attention to detail, problem solving, teamwork, and the ability to handle confidential information in a

Qualifications

• High school diploma or GED required.
• Computer proficiency with Windows-based technologies.
• Ability to be discreet and protect confidential information.
• Prior medical office experience preferred.
• Excellent problem-solving and attention to detail.
• Ability to handle difficult situations with a positive attitude.
• Good interpersonal, oral and written communication.
• Strong organizational and time management skills.
• Ability to meet deadlines; work well in a team.
• Stress management in a fast-paced environment.

Responsibilities

• Monitors outstanding balances to determine next steps in the collection process.
• Follows up on claims and denials to maximize reimbursement.
• Reviews accounts receivable activities and calls on balances or claims.
• Generates insurance paperwork including claim forms and collection letters.
• Reviews EOBs to determine reimbursement accuracy.
• Sends claims for adjudication via portals.
• Investigates and appeals denied or underpaid claims.
• Responds to inquiries from patients and payors by phone or written requests.
• Tracks and resolves discrepancies.
• Follows up on unpaid claims after denial to obtain settlement.
• Audits insurance and patient accounts to identify refunds.
• Responds promptly and courteously to inquiries.
• Provides clear communication and customer service on collection issues.
• Helps patients develop payment plans.
• Identifies patterns indicating potential issues.
• Adheres to policies and supports high-quality customer service.
• Performs other duties as needed.
• Submits billing data to insurance providers.
• Participates in continuing education related to duties.

Skills

Attention to detail

Problem solving

Interpersonal skills

Time management

Teamwork

Communication

Discretion

Multitasking

Independent work

Stress management

Education

High school diploma or GED

Job description

Overview

Responsible for collecting commercial, government, and patient balances by following the approved processes, policies and procedures set by the revenue cycle department.

Responsibilities

• Fully Remote positionMonitors outstanding account balances to determine the next step in the collection process.
• Follows up on claims and claim denials to ensure maximum reimbursement for services provided.
• Reviews accounts receivable activities and calls on outstanding balances or claims.
• Generates appropriate paperwork, including insurance claim forms (original and re-filed) and collection letters.
• Reviews insurance payments (Explanation of Benefits – EOB’s) to determine whether reimbursement is accurate.
• Navigate portals to send claims for adjudication.
• Investigates and appeals denied or underpaid claims.
• Responds to all inquiries received from patients and payors either by telephone or written request.
• Tracks and resolves discrepancies.
• Follows-up on unpaid insurance claims after denial to obtain settlement of claim.
• Audit insurance and patient accounts to determine whether a refund is needed.
• Promptly and courteously responds to all inquiries received from payors and patients either by telephone or written request.
• Provides clear communication and customer service on collection issues to external customers and internal business partners.
• Helps patients develop patient payment plans.
• Identifies patterns and trends that indicate a potential issue.
• Adheres to all policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.
• Performs other duties that may be necessary or in the best interest of the organization.
• Submits billing data to insurance providers.
• Participates in continuing educational activities relative to assigned duties and responsibilities.

Qualifications

• High school diploma or GED required.
• Computer proficiency and experience in windows-based technologies
• Ability to be discrete and security confidential and sensitive information.
• Prior work experience in a medical office setting preferred.
• Excellent problem-solving skills, attention to detail, management of multiple tasks and the ability to do so independently.
• Ability to handle difficult situations with a positive attitude.
• Good interpersonal, oral and written communication skills.
• Strong organizational and time management skills.
• Ability to adhere to deadlines timely.
• Must be able to work as part of a team with peers and leadership within the organization.
• Must possess a high level of interpersonal skills including the ability to respond calmly and make rational decisions in stressful situations.

About

Confluent Health, LLC and its affiliates are equal opportunity employers committed to building a diverse and inclusive workforce. We do not discriminate based on race, color, religion, sex, sexual orientation, gender (including pregnancy, childbirth, or related medical conditions), gender identity or expression, national origin, marital status, age, disability, veteran status, or other applicable legally protected characteristics. If you need assistance or would like to request an accommodation due to a disability, please contact us at