Position Overview:

Reporting to the Hospital Workers Comp Collections Supervisor, the Collector must have a strong knowledge of work comp collections, accounts receivables, insurance billing and verification, denial processing, appeal submission and EOB review. This position is responsible for resolving outstanding surgical claims resulting in maximum reimbursement.

Responsibilities:

• Timely follow-up and resolution on all outstanding workers comp A/R including unpaid/underpaid/denied claims to obtain maximum reimbursement.
• Manage daily work queues to prioritize high dollar claim balances.
• Perform insurance claim follow-ups for insurance denials and appeals. Contact insurance companies to check status via phone, web portals or online.
• Reviewing State fee schedules to ensure claims have processed correctly.
• Knowledge of all payers for workers comp.
• Understanding implant reimbursement.
• Review & work incoming insurance and patient correspondence including refund requests.
• Prepare and write appeals when appropriate or provide the requested medical documentation.
• Ability to review medical documentation.
• Review insurance payments and determine accuracy of reimbursement based on contracts and fee schedules.
• Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers providing the appropriate documentation.
• Understanding workers comp time constraints and making sure they are not exceeded.

Required Skills

• 3+ years of hospital workers comp collections experience preferred. 
• Excellent communication skills and interpersonal skills
• Skilled in time management and prioritization of emergent situations.
• Excellent customer service skills, demonstrating professionalism.
• Ability to read and interpret insurance explanations of benefits and contracts. 
• Knowledge and experience in working with insurance adjusters when needed.
• Intermediate computer proficiency in Microsoft Office including Excel and Outlook.
• nThrive, Cerner, AdvantX, Jopari, and CPSI experience preferred.
• High School Diploma or equivalent.
• Familiar with workers comp rules in all states.
• Extensive DOL experience is a plus.