Description:

Job Description

The healthcare collections specialist is responsible for research, analysis and resolution of high volume, complex customer accounts receivable, order entry exceptions and disputes involving contractual agreements and non-standard billing agreements with hospitals, group purchasing organizations, nursing homes and miscellaneous medical service providers requiring durable medical equipment and associated peripheral medical supplies.

1. Reviews, analyses, and reconciles initial Accounts Receivable and Order Entry exceptions and discrepancies to ensure accurate invoicing and prompt payment within business practice and time sensitive guidelines.

2. Performs extended resolution activities on more extensive exceptions and discrepancies including engaging parties such as Finance Department, National Contact Center, Contracts Area and USA field staff to collect necessary transaction details required to advance the resolution process.

3. Utilizes higher-level knowledge of accounts receivable practices and information systems to identify and remove barriers to account collection.

Facilitates high volume, extensive professional level verbal and written communications to a broad spectrum of internal and external contacts during all resolution activities operating within strict federal credit guidelines and in full compliance with Sarbanes-Oxley regulatory requirements.

4. Researches and verifies all requisite specific transactional information such as contractual stipulations and service dates, initial order entry information, purchase order information, contact information such as price breaks, volume commitment levels, current and actual volume levels.

5. Practices continual autonomous decision-making based on knowledge and understanding of a variety of contractual pricing structures. Facilitates independent actions to assure purchasing and activities are within stated contractual guidelines including recognizing and complying with various dynamic and goodwill pricing structures.

6. Participates in any and all reasonable work activities as may be deemed suitable and assigned by management.

7. Conforms to, supports and enforces all Company policies and procedures.

Specific Duties:

8. To develop, for each Medicare Insurance claim denial, a reasonable patient product use detail and history; to develop and substantiate the product use evidence, and present the patient’s case to Medicare in the manner required or make appropriate adjustments

9. Write a medically concise and issue focused Redetermination, Reconsideration, or Administrative Law Judge letter as required as it applies to Medicare policy

10. Pull patient denials and/or partially paid claims in appropriate numbers in order to maintain timely completion of the Appeals Department filing limit caseload

11. Update accounting system to track denial/payment status

12. Obtain documents/information from health care entities and Medicare portals/customer service that is pertinent to supporting appeal of denied claims

Skills:

technical knowledge, benefit administration, medical coding, excel database, medical record, medical terminology, customer service, call center, health care, medical billing

Top Skills Details:

technical knowledge,benefit administration,medical coding,excel database

Additional Skills & Qualifications:

High School Diploma

Ability to maintain confidentiality and discretion in business relationships and exercise sound business judgment.

2-3 years’ experience performing medical collections

Ability to analyse and resolve complex A/R discrepancies, EOB, claim denials

Demonstrates knowledge of basic accounting skills.

PC skills to include use of Microsoft Excel and Word.

Excellent telephone communication skills and customer service skills.

3-5 years’ experience in collections and A/R

Denials experience

Knowledge of Managed Care, Medicare, Medicaid, HIPPA, Health Insurance Claim Form

(CMS 1500. Form)

Clear understanding of how collections works

How to appeal a claim once denied

Candidate will work all insurance and not just Texas; must be able to adapt and look up provider manuals

Demonstrates excellent problem-solving skills and negotiating skills

Two or more years of related healthcare experience.

Experience Level:

Entry Level

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.