**Rate of pay depends upon Experience**
GENERAL SUMMARY
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.
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.
· Resolve patient accounts, via telephone calls, written correspondence and walk-ins within in an efficient manner.
· 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.
· Must work the agreed number of patient accounts given by 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.
· 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 discuss status of accounts when necessary.
· 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
· 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.
· Complete all education assigned.
· Provide patients and insurance companies with COIB upon request.
· Contact Medicaid, Medicare, Commercial Insurances and or third party payers for status of claims.
· 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.
· 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.
· Maintain a working knowledge of computer software, including CPSI.
· 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 preferred.
· 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, contractual, 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
Benefits:
- 401(k)
- 401(k) matching
- AD&D insurance
- Dental insurance
- Disability insurance
- Employee assistance program
- Employee discount
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Referral program
- Vision insurance
Work Location: In person
