Healthcare Collections Specialist
Description: The healthcare collections specialist is responsible for research, analysis and resolution of high volume, complex customer accounts receivable, order entry exceptions and disputes involving contractual agreements and non-standard billing agreements with hospitals, group purchasing organizations, nursing homes and miscellaneous medical service providers requiring durable medical equipment and associated peripheral medical supplies. MUST HAVE EXPERIENCE: DO NOT APPLY IF YOU DO NOT HAVE THE FOLLOWING EXPERIENCE + Submitting Appeals + Re-working denied medical claims + Reading and understanding an EOB + Calling medical insurance companies PRIMARY DUTIES/RESPONSIBILITIES: o Reviews, analyzes, and reconciles initial Accounts Receivable and Order Entry exceptions and discrepancies to ensure accurate invoicing and prompt payment within KCI business practice and time sensitive guidelines. o Performs extended resolution activities on more extensive exceptions and discrepancies including engaging parties such as Finance Department, National Contact Center, Contracts Area and KCI USA field staff to collect necessary transaction details required to advance the resolution process. Utilizes higher-level knowledge of accounts receivable practices and information systems to identify and remove barriers to account collection. o Facilitates high volume, extensive professional level verbal and written communications to a broad spectrum of internal and external contacts during all resolution activities operating within strict federal credit guidelines and in full compliance with Sarbanes-Oxley regulatory requirements. o Researches and verifies all requisite specific transactional information such as contractual stipulations and service dates, initial order entry information, purchase order information, contract information such as price breaks, volume commitment levels, current and actual volume levels. o Practices continual autonomous decision-making based on knowledge and understanding of a variety of contractual pricing structures. Facilitates independent actions to assure purchasing and activities are within stated contractual guidelines including recognizing and complying with various dynamic and goodwill pricing structures. o Participates in any and all reasonable work activities as may be deemed suitable and assigned by management. o Conforms to, supports and enforces all Company policies and procedures. Must have Skills: collection, accounts receivable, accounting, medical record, medical terminology, customer service, call center, health care, medical billing, medical claims processing Top Skills Details: collection,accounts receivable,accounting Additional Skills & Qualifications: REQUIRED QUALIFICATIONS: High School Diploma Ability to maintain confidentiality and discretion in business relationships and exercise sound business judgment. 3 years' experience performing medical collections Ability to analyze and resolve complex A/R discrepancies Demonstrates knowledge of basic accounting skills. PC skills to include use of Microsoft Excel and Word. Excellent telephone communication skills and customer service skills. Demonstrates excellent problem-solving skills and negotiating skills MANAGER FEEDBACK - EXP NEEDED 3-5 years' experience in medical collections and A/R (Manager is OK with less experience, as long as candidate has experience in Insurance Collections) Denials experience - How to appeal an insurance claim once denied, investigate, correct and resubmit for payment Knowledge of Managed Care, Medicare, Medicaid, HIPPA, Health Insurance Claim Form (CMS 1500. Form) Clear understanding of how collections works Read and understand an Explanation of Benefits (EOB) Have experience with Medial Records and RX's Candidate will work all insurance/payers and not just Texas; must be able to adapt and look up provider manuals NO debt collections Will call insurance companies not people nor facilities Needs at least 2 years in healthcare environment - Dr offices, hospitals, etc. Medical records appeals Positive personality - has to show they want the job and eager to learn Experience submitting appeals to an insurance company ESSENTIAL FUNCTIONS: Requires repetitive keyboarding over 95% of the time and phone usage 60% of the time. The information listed above is not a comprehensive list of all duties/responsibilities performed. This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice. Experience Level: Intermediate Level About Aston Carter: At Aston Carter, we're dedicated to expanding career opportunities for the skilled professionals who power our business. Our success is driven by the talented, motivated people who join our team across a range of positions - from recruiting, sales and delivery to corporate roles. As part of our team, employees have the opportunity for long-term career success, where hard work is rewarded and the potential for growth is limitless. Established in 1997, Aston Carter is a leading staffing and consulting firm, providing high-caliber talent and premium services to more than 7,000 companies across North America. Spanning four continents and more than 200 offices, we extend our clients' capabilities by seeking solvers and delivering solutions to address today's workforce challenges. For organizations looking for innovative solutions shaped by critical-thinking professionals, visit AstonCarter.com. Aston Carter is a company within Allegis Group, a global leader in talent solutions. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please call or email (%) for other accommodation options. However, if you have questions about this position, please contact the Recruiter located at the bottom of the job posting. The Recruiter is the sole point of contact for questions about this position.