PFS Collection Specialist

Confluent Health LLC; United States; On-site; USD 38,000 - 54,000; Full time

Job summary

Confluent Health LLC is seeking a detail-oriented collections specialist responsible for collecting commercial, government, and patient balances by following approved Revenue Cycle policies and procedures. You will follow up on claims, monitor balances, and generate necessary documentation to maximize reimbursement.

The role emphasizes communication with patients and payors, portal navigation for adjudication, and adherence to high service standards across our healthcare network.

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.

Responsibilities

• Follows up on claims and claim denials to ensure maximum reimbursement for services provided.
• Monitors outstanding account balances to determine the next step in the collection process.
• 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.

Skills

Computer proficiency

Discretion

Education

High school diploma or GED

Job description

Overview

At Confluent Health, we believe great patient care starts with investing in great people. Across our nationwide family of healthcare companies, we give our teams the tools, development, and opportunities to grow their careers, make an impact, and do meaningful work every day. Come grow with us and help make healthcare—and the communities we serve—stronger.

In this role you will be responsible for collecting commercial, government, and patient balances by following the approved processes, policies and procedures set by the revenue cycle department.

Responsibilities

• Follows up on claims and claim denials to ensure maximum reimbursement for services provided.
• Monitors outstanding account balances to determine the next step in the collection process.
• 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 [e-mail].