PFS Collection Specialist

Confluent Health LLC; Oregon; Hybrid; USD 40,000 - 55,000; Full time

Job summary

Confluent Health LLC is seeking a remote Accounts Receivable Specialist to manage patient and payer balances following approved revenue cycle procedures.

Responsibilities include monitoring outstanding balances, following up on claims and denials, generating claim forms, reviewing EOBs, and communicating with payors and patients to resolve accounts and set up payment plans. The role emphasizes accuracy, confidentiality, and teamwork.

Qualifications

• Must have computer proficiency with Windows-based technologies.
• Strong problem-solving skills and attention to detail.
• Ability to manage multiple tasks and meet deadlines.
• Excellent interpersonal, oral and written communication abilities.

Responsibilities

• Monitors outstanding account balances to determine next steps in collections.
• Follows up on claims and denials to maximize reimbursement.
• Reviews accounts receivable activities and contacts payors or patients.
• Generates insurance claim forms and collection letters as needed.
• Reviews EOBs to verify accurate reimbursements and adjudicates claims.
• Investigates and appeals denied or underpaid claims.
• Responds to inquiries from patients and payors by phone or in writing.
• Tracks and resolves discrepancies and helps set up patient payment plans.

Skills

Computer proficiency

Problem-solving

Multitasking

Interpersonal communication

Time 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 position

• Monitors 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 .