Job description

Medical Collections Specialist - Urgent Care

Position Summary:

The "Medical Collections Specialist" will work in the Accounts Receivable/Billing department, within our CBO (Central Billing Office). Collectors will be responsible for the thorough and timely patient account follow up to ensure accurate A/R reporting. Collectors will follow up on outstanding claims and interact with various payors (Commercial, Government, and Worker’s comp) to ensure that payments are received accurately and timely.

Reports To: Director of Billing and Collections

Location: 5208 Tennyson Pkwy, Plano, TX, 75024 - This is not a remote role

Hours:

• 8:00am – 5:00pm
• Workdays alternate every other week
• Week 1: Monday – Friday
• Week 2: Tuesday – Saturday

Pay: $23-26/hr

Who we are Looking for:

• 3-5+ years experience with: Outpatient billing – Family, Internal, General, Urgent Care, etc

Experience with NCCI edits and CMS 1500 claim form experience
Resolving claims based on remittance and denial codes

• Big plus if knowledgeable in Advanced MD billing software
• Experience with various payors - Commercial, Government, and Worker’s Comp
• Experience reaching out to Insurance carriers for collection purposes
• Ability to be polite, direct, and solution orientated with ALL personnel
• Ability to write or modify letters of appeal with a high level of detail
• Coding certification is a plus (CMC, CPC, CCC, CCS, etc)

Workflow Summary:

We currently use Experity’s PV (Practice Velocity) Medical Record Software for in office charting and Advanced MD billing software.

• We use a unique tailored system (DANNY) to do an initial pre-scrub of the PV charts, import that pre-scrubbed data into Advanced MD where work is put in 1 of 4 buckets: (1) Chart review, (2) Inspector, (3) Exclusion, and (4) Unbilled
• These buckets are where work is assigned and executed.
• We have contracts in place to bill for (1) Family Practice and/or (2) Urgent Care services
• Candidates should be knowledge in billing/revenue cycle for relatable claims – General Medicine, Internal Medicine, Urgent Care, or other similar outpatient billing services

Qualifications:

• HS Diploma/GED
• 3-5 years outpatient claim experience – specifically with CMS 1500
• Ability to run reports in excel and articulate findings
• CMS1500 claim form experience, working denials & sending letters of appeal is a must
• Experience reading insurance policies, Fee schedules, and EOBs/ERAs
• Coding certification is a plus (CMC, CPC, CCC, CCS, etc)

Responsibilities

• Follow up with appropriate parties (patients and insurance carriers) via phone and email for timely and accurate payment collections
• Handles contracted and non-contracted, HMO, PPO, EPO, POS, Worker's Comp, self-pay and third-party reimbursement issues.
• Expectation is resolving, correcting, or resubmitting 70-75 accounts per day
• Effectively and independently handles second level reimbursement issues, contracted and non-contracted denials for serviced before and after procedures
• Works all denials and corrected claims collaborating with the biller and/or Business Office Manager, insurance payers and/or patients on past due accounts
• This role is primarily focused on collecting payments from insurance companies as opposed from collecting from self-payers/individuals.
• Meeting and maintaining cash collection metrics and goals
• This is a fast-paced environment, which requires attention to detail, accountability, teamwork, and professional behavior and a focus that extends to patients, clients, and other departments

Benefits for full-time employees:

• Health Insurance
• Dental Insurance
• Vision Insurance
• Life Insurance
• PTO
• Up to 4 Free CommunityMed Clinic visits each year

Job Type: Full-time

Pay: $23.00 - $27.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday
• Weekend availability

Ability to commute/relocate:

• Plano, TX: Reliably commute or planning to relocate before starting work (Required)

Application Question(s):

• Please list what billing softwares you have experience using ie) Advanced MD - 2 years; EPIC - 5 years; NextGen - 7 years; etc)

Education:

• High school or equivalent (Preferred)

Experience:

• Reading EOBs/ERAs: 3 years (Preferred)
• Using CMS 1500 claim forms: 3 years (Preferred)
• Commercial Insurance (BCBS, Cigna, United, etc): 3 years (Preferred)
• Medicare: 2 years (Preferred)
• Workers' Comp: 2 years (Preferred)
• NCCI Edits: 3 years (Preferred)
• Writing/Sending Letters of Appeal to Insurance Carriers: 3 years (Preferred)

License/Certification:

• Billing or Coding Certification (CMC, CPC, CCC, etc) (Preferred)

Work Location: One location

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