Collections Specialist

GENERAL SUMMARY

**Pay depends upon experience**

The Collections Specialist is responsible for part of the Accounts Receivable Process for the Billing Office at CPSH, particularly Collections. This includes demographic entry, claims transmission, customer service, documentation, collections, and accounts receivable follow-up. This position is responsible for resolution of patient accounts by obtaining insurance billing, reimbursement, and continually staying abreast of delinquent accounts. Duties are performed in coordination with other Billing/Collections Staff, especially the CFO and the Director Patient Financial Services.

DUTIES AND RESPONSIBILITIES

· Demonstrate daily in all job functions and interactions with patients, customers, coworkers, Managers, and physicians the mission and Standards of Behavior of Cypress Pointe Surgical Hospital.

· Perform job duties professionally, consistently, and effectively to maintain and/or exceed assigned goals to support the success of the department and Cypress Pointe Surgical Hospital.

· Daily support Management and coworkers in a positive manner demonstrated verbally and by actions.

· Resolve patient accounts, via telephone calls, written correspondence and walk-ins within 48 hours.

· Within 48 hours, responds to telephone and written inquiries from patients, physician offices and insurance companies promptly and courteously.

· When necessary, obtain Insurance information and add appropriate carrier/plan information, ensuring that all steps have been completed so that proper billing, follow up and reimbursements can be obtained.

· Continue working knowledge of hospital contracts and how they relate to the reimbursement of charges.

· Explain patient accounts to them in terms that they can understand, attempt to peacefully resolve complaints of problem accounts within 48 hours.

· Must work the agreed number of patient accounts given by Patient Financial Services Management Team by working the accounts by collection methods and follow up on outstanding insurance, patient balances and private pay accounts assigned.

· Work accounts by collection methods and follow up on outstanding insurance, patient balances and private pay accounts assigned.

· Make financial agreements, per the payment plan policy, including but not limited to employee payroll deduction as well as the ability to make monetary collections.

· Sorts and delivers outgoing mail and other mail for the Patient Financial Services Department.

· Process, compile paperwork and mail refund checks weekly.

· Research and write up account adjustments on the proper adjustment form and route for the appropriate signatures of authorization, as outlined in the adjustment policy.

· Reconcile credit balances, including but not limited to the refunds when necessary.

· Call patients to obtain financial information, insurance information and discussing status of accounts when necessary.

· He/she must be a positive role model for other staff members and patients by working with them to promote teamwork and cooperation.

· Responsible for routing denials on the Explanation of Benefits to the Revenue Integrity Lead for follow-up.

· Document daily in notes all information or activities that pertain to the account.

· Must be able to accept constructive criticism and integrate suggestions in effective ways.

· Maintain confidentiality and adhere to HIPPA Compliance on a daily basis.

· Routinely audit and evaluate the processes, errors identified, etc. to develop a plan to continuously keep the process of adjustments and account demographics accurate to ensure proper collection of revenue.

· Must be able to handle potentially stressful situations and handle multiple tasks at one time.

· Attend all in-services and trainings.

· Notify Management of critical issues within department.

· Complete all education assigned.

· Assist with the training of other departmental staff.

· Assist in processing mail for department.

· Provide patients and insurance companies with COIB upon request.

· Contact Medicaid, Medicare, Commercial Insurances and or third party payers for status of claims.

· Help to resolve problems in the admissions area according the hospital policy.

· Work reports as assigned by Management within the set time frames and accurately.

· Transfer patient balance daily after insurance pays and or denies deemed appropriately.

· Call or write patients, insurance companies and employers for additional information needed to process claims when necessary.

· Work with Revenue Integrity Lead and the Director of Patient Financial Services on a regular basis to enlist their assistance on hard to collect accounts.

· Have knowledge of the billing and posting processes performed by the Billing Specialist and how it relates to the collection of outstanding claims for assigned payers.

· Request any information appropriate to collect and process claims.

· Maintain a working knowledge of computer software, including CPSI.

· Handle special request from administration.

· Establishes work priorities related to patient satisfaction.

· Assist in working quarterly reports.

· Identify admit related errors to expedite the payment process in the future.

· Other duties as assigned/ required.

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job related tasks other than those stated in this description.

EDUCATION/QUALIFICATIONS

· Satisfactory completion of high school or equivalent.

· A minimum of 2 years in a medical business office.

· Knowledge of payer practices and guidelines, reading an Explanation of Benefits and able to apply payments, contractuals, and patient responsibility, able to explain account activity in terms that the patient will understand, knowledge of UB04 billing form and billing requirements.

· Excellent written and verbal communication.

· Excellent organization and attention to detail

Job Type: Full-time

Pay: From $16.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• AD&D insurance
• Dental insurance
• Disability insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Weekly day range:

• Monday to Friday

Work setting:

• Office

Education:

• High school or equivalent (Required)

Experience:

• Medical Office: 1 year (Required)

Work Location: In person