Medical Insurance Collector

The Medical Insurance Collector is required to collect complex denials, prepare appeals, and take 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, you must possess in-depth knowledge of collection processes and medical insurance policies. The ideal candidate must also demonstrate excellent written and verbal communication skills, as they will communicate with various insurance companies and customers. This position requires an individual who can multi-task, problem-solve, and manage time effectively. 

Job Requirements/Qualifications

• MUST HAVE 3 YEARS OF MEDICAL INSURANCE COLLECTION EXPERIENCE WITH AN EMPHASIS ON MEDICARE INSURANCE COLLECTIONS. 

• 3 - 4 years of previous billing experience, with emphasis on Medicare billing 

• 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 

• Experience in the DDE system and Novitasphere 

• Working knowledge of the CMS 838 credit balance report 

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

• Preference shown to previous experience in a Facility setting. 

• Function as a subject matter expert (SME) for Medicare 

• Function as a subject matter expert (SME) for the following appeals: 

• Clinical 

• Medical Necessity 

• Authorization 

• Non-Covered 

• Underpayments 

Essential Job functions and responsibilities

• Investigates and responds to inquiries from payors. 

• Research errors and makes 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 amounts before approving patient statements. 

• Review insurance EOBs and initiate appeals as necessary 

• Resolves all insurance requests, inquiries, and concerns expediently and respectfully. 

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

• Must think outside 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.