Position Overview: Reporting to the Hospital Collections Supervisor, the Level III - High Dollar Collector is responsible for the follow-up and resolution of high-balance Insurance accounts. This role requires extensive knowledge of insurance payers, appeals processes, clinical policies and medical billing practices. The ideal candidate will be detail-oriented, proactive, and skilled in resolving complex account issues to ensure timely and accurate reimbursement.

Responsibilities:

·Completes in-depth reviews and timely follow ups on high-dollar accounts (typically $10,000 and above) to ensure claim resolution to obtain maximum reimbursement.

·Identifies trends or issues causing delays or denials, escalating to all appropriate parties.

·Must write targeted appeals and reconsiderations for denied or underpaid claims.

·Reviews medical records, summary plan documents, and contracts to determine if we have cause for medical necessity.

·Leverages knowledge of all payers BCBS, Aetna, UHC, Cigna, Commercial, and Managed Medicare.

·Reviews insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents.

·Extensive knowledge of Fee Schedules and Payor Contracts

·Works closely with cross functional departments such as billing, coding, and payment posting to resolve account discrepancies.

·Facilitate effective communication with insurance carriers, patients, and internal departments to resolve outstanding balances

·Works a minimum of 30 accounts daily with > or = 90% accuracy rating; must meet department productivity standards.

Required Skills

·5-10 Years Surgical Hospital or Acute Care Hospital experience

·Strong knowledge of commercial and government payers (Medicare, Medicaid, BCBS, UHC, etc.).

·Must demonstrate a positive demeanor, excellent verbal and written communication skills, and must exhibit professionalism.

·Must be able to handle potentially high stress situations and handle competing priorities while meeting or exceeding deadlines.

·Maintains appropriate account-level reviews to ensure timely account processing.

·Experience with Cerner and Nthrive required. Additional payer portal experience is a plus.

·Must have Intermediate computer proficiency in Microsoft Office, including Excel and Outlook.

·Strong mathematical skills, research, analysis, decision making, and problem-solving skills.

·Demonstrates excellent problem-solving skills and negotiating skills.

·Strong understanding of medical terminology and CPT/ICD-10 coding

·Personal qualities of integrity, credibility, accountability, and commitment to the organization; displays a proactive, hands-on approach partnering with stakeholders to enhance overall value and visibility of the organization.

·High school graduate or equivalent