Medical Insurance Collector (Greater Houston Resident)

Medical Insurance Collector

Must live in the Greater Houston area / Remote (potential after 30 business days and satisfactory completion of training assessed by assigned manager)

We are a dynamic, quickly growing company based in Houston, TX. We provide medical billing services to numerous healthcare facilities to allow the physicians and nursing staff the ability to focus on providing quality care to patients.

Position Summary (Purpose)

The Medical Insurance Collector is required to perform collection activities on complex denials and prepare appeals and other necessary actions on outstanding balances for BCBS, UHC, Aetna/Cigna and self-funded/commercial providers in the professional/facility fee environment. Our facilities are out of network with all payers.

To succeed in this role, you must possess in-depth knowledge of collection processes and Medical Insurance policies. The ideal candidate must also be able to demonstrate excellent written and verbal communication skills, as they will be communicating with various insurance companies and customers. This position requires an individual that can multi-task, problem solve, and manage time effectively.

Job Requirements/Qualifications

· MUST HAVE 3 PLUS YEARS OF MEDICAL INSURANCE COLLECTION EXPERIENCE (REQUIRED).

· Organized, self-sufficient, analytical, and detail oriented.

· STRONG knowledge of insurance plan providers- BCBS, UHC, Aetna/Cigna and self-funded/commercial providers required.

· Knowledge of Electronic Medical Records, Collections, Payment Posting, Reimbursement, Billing, and Hospital Experience

· REQUIRED Knowledge of EOBs, HIPAA, ICD-10 codes, and CPT codes

· Knowledge of payer systems

· Once remote transition is completed, you must be able to effectively work from home.

Essential Job functions and responsibilities

· Investigates, and responds to inquiries from payors.

· Researches any errors and makes necessary corrections for clean claim production and submissions.

· Follow-up on accounts to ensure timely filing and prompt payment.

· Actively review billing / collection policy changes for assigned payers.

· Follow-up on payment errors, review posting, and calculate allowable amount before approving patient statements.

· Review insurance EOBs and initiate appeals as necessary

· Resolves all insurance requests, inquiries, concerns, in an expedient and respectful manner.

· Work accounts to ensure payment meets the qualified payment amount required by the No Surprises Act

· Must be able to think outside of the box, critical decision making is necessary to fulfill the position’s expectations.

· Meet and exceed departmental goals set by the company and department manager.