Revenue Operations Specialist Iii - Collections

Job Title: Revenue Operations Specialist III - Collections
Reports To: Revenue Operations Collections Manager
FLSA Status: Non-Exempt

GENERAL PURPOSE OF THE JOB:
The Collections Specialist III ensures that all collection activity is performed and completed accurately. This position is responsible and knowledgeable of Medicare, Medicare Advantage, Commercial and Medicaid Managed plans. This position is also responsible for timely filing and following up with insurance payors on unpaid submitted claims to maintain a fluent revenue cycle. Assists management with Revenue Cycle support, training, and reporting.

PRIMARY DUTIES AND RESPONSIBILITIES:
• Identify trends and perform root cause analysis on unpaid and underpaid claims
• Escalated appeals, claim rejections, underpayments, and denials
• Sustain knowledge of all insurance contracts
• Manage Advantage Patient Program applications
• Facilitate and maintain Patient Statement review process and other invoicing needs
• Develop and monitor progress of all appeals
• Credit balance management
• Report and track outside collection agency activity
• Works with management to develop goals, objectives, and competencies for the Revenue Cycle Team
• Provides onboarding and training for the Collection Team
• Month-end close activities and reporting
• Ensures the confidentiality of patients and employee information in compliance with HIPAA guidelines

QUALIFICATIONS:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Minimum 2+ years of related prior work experience required, healthcare and medical billing/collections experience is preferred
• High school graduate or equivalent; associates or bachelor’s degree preferred
• Ability to research and problem solve, using analytical and critical thinking skills
• Intermediate computer proficiency in Microsoft Office including: Word, Excel, and Outlook
• Demonstrated history of resolving challenging issues
• Must possess outstanding communication and interpersonal skills, be able to communicate professionally and effectively
• Ability to work effectively in a team environment and independently
Revenue Operations Specialist III - Collections Page 2 of 2 Last Updated: 01/20/2023

WORK ENVIRONMENT & PHYSICAL DEMANDS:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. The physical demands described below are representative of those that must be met by an employee to successfully perform the essential functions of this job.
The noise level in the work environment is usually low to moderate.
The employee is frequently required to sit and infrequently required to stand, lift and/or move up to 25 pounds. While performing the duties of this job, the employee is required to sit, stand; walk and talk, and hear. Requires excellent visual dexterity and manual dexterity.