Revenue Cycle Specialist - Collector
United Surgical Partners International
- Remote, OR
- Permanent
- Full-time
- 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.
- 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.
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