RCM Quality Assurance Analyst

United Surgical Partners International, Inc; Dallas (TX); On-site; USD 45,000 - 65,000; Full time

Job summary

United Surgical Partners International, Inc. is seeking an A/R Specialist- Collector in the Dallas area to resolve outstanding surgical claims and maximize reimbursement. You will manage high-value accounts, review denials, and prepare documentation for appeals in coordination with payers.

The role requires 2+ years in ASC revenue cycle or orthopedic collections, strong communication, and proficiency with Excel/Outlook. On-site position with strong collaboration across departments.

Qualifications

• 2+ years ASC revenue cycle or orthopedic collections experience.
• Ability to read and interpret EOBs and managed care contracts.
• Clear verbal and written communication with internal and external clients.
• Capable of multi-tasking and meeting deadlines.
• Experience with multiple health payers is preferred.
• Proficient in Microsoft Office including Excel and Outlook.

Responsibilities

• Timely follow-up and resolution on all outstanding A/R to maximize reimbursement.
• Manage daily work queue to prioritize high-dollar claims.
• Review incoming insurance and patient correspondence including refunds.
• Send appeals or provide requested medical documentation.
• Review medical documentation to justify medical necessity.
• Review patient balances for accuracy and collect payments.
• Answer calls to resolve billing inquiries and balances.
• Review insurance payments for accuracy against contracts and schedules.
• Leverage Medicare/Medicaid/LCD knowledge for resolution.
• Negotiate payment amounts with TPA for out-of-network providers.
• Recommend adjustments or refunds with proper documentation.
• Perform other duties as assigned.

Skills

A/R Collections

ASC Revenue Cycle

Excel & Outlook

Communication

Education

High School Diploma or equivalent

Tools

Advantx

Vision

HST

Waystar

Job description

Position Overview

Reporting to the Client Operations Manager, the A/R Specialist- Collector must have a strong knowledge of medical collections, accounts receivables, insurance billing and verification, denial processing, appeal submission and EOB review. This position is responsible to resolve outstanding surgical claims resulting in maximum reimbursement.

Position Overview

Reporting to the Client Operations Manager, the A/R Specialist- Collector must have a strong knowledge of medical collections, accounts receivables, insurance billing and verification, denial processing, appeal submission and EOB review. This position is responsible to resolve outstanding surgical claims resulting in maximum reimbursement.

Responsibilities

• Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers including self-pay to obtain maximum reimbursement.
• Manage daily work queue to prioritize high dollar claim balances.
• Review & work incoming insurance and patient correspondence including refund requests.
• Send appeals when appropriate or provide the requested medical documentation.
• Ability to review medical documentation to justify medical necessity.
• Review patient balances to ensure accuracy and follow up with patients to obtain payments.
• Take incoming patient phone calls to resolve inquiries, billing issues, or outstanding balances.
• Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents.
• Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD’s) for claim resolution.
• Negotiate payment amounts for procedures with Third Party Administrators for out of network providers.
• Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.
• Other duties as assigned.

Required Skills

Requirements

• 2+ years of ASC revenue cycle OR orthopedic collections experience.
• Ability to read and interpret insurance explanations of benefits and managed care contracts.
• Must communicate effectively, both verbally and in writing, with internal and external clients.
• Must be able to multi-task and handle competing priorities while meeting or exceeding deadlines
• Knowledge or experience working with a variety of health care insurance payers is preferred
• Intermediate computer proficiency in Microsoft Office including Excel and Outlook
• Advantx, Vision, HST, Waystar experience preferred.
• High School Diploma or equivalent.