Experienced Medical Infusion Collection Specialist
- A high school diploma or general education degree (GED) equivalent is required.
- 3-5 years of healthcare industry experience required.
- 3-5 years of medical billing and collections experience required.
- Home Infusion, experience preferred.
- CPR +/Caretend experience a plus
- Recognizes patients’ rights and responsibilities and supports them in the performance of job duties, respects patient’s rights to privacy and confidentiality.
- Follows up on invoices submitted to ensure prompt and timely payment and escalates issues, as necessary.
- Evaluates payments/denials received for correctness and ensures they are applied accordingly.
- Identifies bad debt write-offs and A/R adjustments. Initiates write-offs and adjustments in accordance with policies and procedures.
- Identifies any overpayments and/or duplicate payments and investigates and resolves accordingly.
- Processes refund requests, in accordance with policies and procedures.
- Maintains contact with other departments to obtain patient or insurance information needed for claim payment.
- Responsible for understanding all procedures within regulatory mandates.
- Ensures that the activities of the collection operations are conducted in a manner that is consistent with overall department protocol, and are following Federal, State, and payer regulation, guidelines, and requirements.
- Verifies billing accounts with accounts receivable ledger to ensure that all payments are accounted for and properly posted.
- Makes calls to troubleshoot payment discrepancies and establish resolution.
- Documents, in detail, phone calls, phone number, person spoken to, and call details on a consistent basis.
- Consistently looks for areas to maximize claim reimbursement.
- Resolves issues that created a denial within 5 days of receipt of denial.
- Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
- Maintains understanding of NDC (National Drug Code) numbers, metric quantities, and knowledge of infusion supplies.
- Maintains a broad range of knowledge of insurance plans, medical terminology, billing procedures, government regulations, and medical codes.
- Shares knowledge gained with other staff members and works as a team member.
- Interacts with others in a positive, respectful, and considerate manner.
- Performs other job-related duties as assigned.
- Understanding of all Revenue Cycle Management functions and integration of one another.
- Ability to recognize, evaluate and exercise good judgment in solving complex situations and advising in accordance with laws and regulations.
- Excellent verbal and written communication and relationship building skills with an ability to prioritize, negotiate, and work with a variety of internal and external stakeholders.
- Strong work ethic with personal qualities of integrity and credibility.
- Ability to deal with highly sensitive and confidential material, strong knowledge of HIPAA privacy guidelines and requirements.
- Competence with ICD-9 and ICD-10.
- Knowledge of medical terminology.
- Ability to assist in leading a diverse department in an environment with frequent changes and priorities.
- Ability to communicate effectively and professionally with patients, visitors, physicians, and coworkers.
- Self-directed, detail oriented, conscientious, organized, and able to follow through.
- Ability to train employees, to include organizing, prioritizing, and scheduling work assignments to meet timelines.
- Ability to deal in an organized manner with problems involving multiple variables within the scope of the position.
- Skill in establishing and maintaining effective working relationships with other employees, patients, organizations, and the public.
- Tolerant of frequent interruptions and distractions from staff and other internal support teams.
- Proficient in Microsoft Office, including Outlook, Word, and Excel.
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