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Oceans Healthcare · 6 days ago

Collections Specialist

Plano, TX

Full-time

Onsite

New Grad, Entry Level

Oceans Healthcare is seeking a Collections Specialist responsible for accurate and timely billing and collection of outstanding receivables from third party payers. The role involves reviewing claims, performing follow-ups, and ensuring accurate account balances while maintaining communication with various stakeholders.

Health Care

Responsibilities

Reviews third party claims for accuracy and completeness using patient accounting functionality. Submitting claims to third party payers within timely filing restrictions

Performs follow up activities by telephone or electronic inquiry on accounts with outstanding third party payer balance to determine status of claims in accordance with payer specific follow-up guidelines

Attempts to expedite claim adjudication by resolving issues that may delay processing, involving the patient/guarantor as necessary

Clearly and concisely documents pertinent follow up activity upon completion of each occurrence in patient accounting system

Resubmits claims to payers as necessary - submitting secondary or tertiary plan claims as required

Ensures accurate account balances for proper account processing and reporting, requesting contractual allowances, adjustments , and balance transfers as necessary

Communicates with other revenue cycle staff members, Utilization Review/Case Management, and site leadership to ensure timely and accurate claims payments

Researches and resolves credit balance accounts as requested by payers or as identified on aging reports

Completes daily and weekly productivity/performance reporting as directed by management

Performs other duties and projects as assigned

Qualification

Patient accounting systemsThird party payersMicrosoft Office productsEffective communicationCustomer service skillsTeamworkConfidentiality

Required

High school diploma or equivalent as minimum requirement

Previous experience with interpretation of insurance plan benefits, conditions of payment, and billing requirements

Experience in Microsoft Office products and general patient accounting systems

Knowledge of third party payers, Medicare, Medicaid, and other payer requirements

Effective communication abilities for phone contacts with insurance payers to resolve claim issues

Customer service skills for interacting with patients regarding medical claims and payments, including communicating with patients and family members of diverse ages and backgrounds

Able to work in a team environment

Ability to function with minimal supervision and complete understanding and respect of confidentiality

Follows policy and procedures that are in accordance with State and Federal Laws, JCAHO, HCFA and other regulatory boards as required by state and federal laws as well as the mission statement

Preferred

Previous customer service experience in a similar field, including employment as a call center worker, credit authorizer or customer service representative, is also beneficial