The Collections Representative engages in collection activities and ensures maximum reimbursements in compliance with departmental standards, HDL policies and procedures, billing system, and healthcare governing agency policies and procedures.
Essential Functions/Responsibilities (other duties may be assigned):
• Responsible for the follow-up on all denied or rejected claims and or correspondence from the insurance carriers.
• Responsible for correcting demographic, insurance information or coding and modifiers on denied line items
• Initiate follow-up letters with referring practice regarding missing information for unpaid/unprocessed claims
• Remain current on commonly-used concepts, practices and procedures within the field of healthcare insurance billing.
• Follow-up with insurance carriers in a timely manner on unpaid/incorrectly paid claims; requesting redeterminations and or appeals as needed
• Ability to work in a production environment and meet productivity goals
• Utilize payer websites to appeal or gather information to rectify outstanding balances
• Research payer requirements and make corrections or adjustments towards adjudication of patient
• Identify and trend payments and denials; referring issues to supervisor or management for resolution
• Provide support to Order Entry Representatives as dictated by the needs of the business and assist in training of new employees
• Adhere to HIPAA guidelines to protect patient confidentiality
Required Education, Skills and Experience:
• Minimum education includes a high school diploma or equivalent, but associate’s degree is preferred
• One-five years of healthcare insurance collections experience
• Ability to interpret and analyze EOBs, remits and payment posting entries is mandatory
• Working knowledge of major payers and their websites necessary
• Previous medical laboratory experience is preferred
• Ability to communicate well through written and verbal means is required
• Requires computer proficiency and a high degree of proficiency with the Microsoft Office Suite to include Excel
• Knowledge of ICD-9 Codes and CPT codes
• Attention to detail, accuracy, time management and organizational skills
• Knowledge of commonly-used concepts, practices and procedures within the field of healthcare insurance.
• Ability to maintain strict HIPAA compliance
• The ability to multi-task, prioritize, work under pressure and a commitment to achieving customer satisfaction is the key to success in this position