Insurance Collections Specialist

POSITION FUNCTION/OVERVIEW:

This position will focus on accuracy in reviewing and assessing insurance denials or returned claims. Must be able to communicate with insurance companies and clients from a resolution based perspective. This communication should be focused on acquired knowledge, insurance carrier guidelines, company policies & procedures, research and collection efforts. In addition to following up on claims, the collection specialist will be responsible for sending out medical records and writing appeals for denials to the insurance companies.

PRIMARY DUTIES/RESPONSIBILITIES:

• Promote the mission, values and vision of the organization.

• Provide excellent customer service for clients; practices confidentiality and privacy protocols in accordance with HIPAA requirements.

• Accurately and thoroughly enters data / notes into the electronic system for follow up.

• Assists with follow up on claims processed to ensure payment to the agency.

• Works directly with payers to verify client eligibility and client payment responsibility including co-pays, deductibles, co-insurance, and/or out of pocket maximums.

• Assists as needed with follow-up on insurance denials, appeals, and reconsiderations.

• Assists as needed with all billing tasks and functions related to insurance, grant, and client billing.

• Responsible for investigating insurance rejected claims and the re-processing of denied claims and/or appeals of denied or underpaid claims.

• Identify denial patterns, as well as notifying senior management of payment delay issues.

• Contacts insurance companies regarding outstanding accounts.

QUALIFICATIONS REQUIRED:

• High School Diploma or GED equivalent with combination of education and work experience, required; Bachelor’s degree, preferred.

• Minimum of two (2) years’ experience in Substance abuse Billing, Coding and Collections.

• Knowledge of Third Party payers, billing requirements and reimbursement methods; knowledge of medical terminology. 

• Knowledge of claims reimbursement and collection efforts for the field of Substance Abuse treatment.

• Relevant computer software and hardware applications proficiency – Word, Excel, PowerPoint, Outlook, Electronic Medical Records, Billing Systems and/or other scheduling applications; KIPU preferred, Collaborate MD

SKILLS:

• Strong communication skills, both written and verbal.

• Ability to work independently, as well as part of a team.

• Manage multiple tasks and set priorities.

• Ability to handle highly sensitive and confidential information.

• Ability to work in a fast-paced, high-energy environment.

• Excellent interpersonal and customer-facing skills.

• Ability to work accurately, with attention to detail.