The Department of Orthopaedic Surgery is seeking a full-time Collections Specialist to join the production unit team. This person will be responsible for the collections of unpaid medical insurance claims, and follow up on unpaid medical claims, as well as appealing these claims.

Specific Duties & Responsibilities

• Uses system collection reports, such as: aged trial balances, data search reports, and the Paperless Collection System (PCS) to identify unpaid claims for collection/appeals.
• Communicates with third-party payers, patients, physicians, and other parties to resolve unpaid claims.
• Reviews and updates patient registration information (demographic and insurance) on IDX as needed.
• Utilizes PCS to process A/R. Works PCS files to completion.
• Applies appropriate discounts/courtesies based on department policy.
• Prints and mails claim forms and statements according to the follow-up matrix. Retrieves supporting documents (medical reports, authorizations, etc.) as needed and submit to third-party payers.
• Identifies and informs the Supervisor/Production Unit Manager of issues or problems associated with non-payment of claims.
• Appeals rejected claims and claims with low reimbursement.
• Identifies and informs management of systems or operational issues affecting collections, reimbursement and/or day in accounts receivable.
• Processes third-party payer correspondence for resolution and/or payment of claims.
• Research and resolve Production Unit posting errors during the month.
• Performs miscellaneous-related duties and special projects as assigned.

Minimum Qualifications

• High School Diploma or graduation equivalent.
• One year experience in a medical billing or similar specialty environment is required. Knowledge of medical terminology, CPT/ICD codes, and diagnosis coding is also required.

Preferred Qualifications

• Two years of related experience.
• Ability to use various billing and patient information computer systems.
• Knowledge of various payer processing and submission guidelines. Experience in IDX and PCS. Knowledge of third-party payer requirements.

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