Responsible for collection of unpaid third-party claims and appeals. Works with the payers’ to resolve issues and facilitate prompt payment of claims.
Specific Duties & Responsibilities
1. Utilizes the EPIC system for the daily flow of accounts to identify unpaid claims for follow-up.
Communicates with third-party payers, patients, physicians, and other parties to resolve unpaid claims. Review and update patient registration information (demographic and insurance) in EPIC as needed.
Posts appropriate adjustments and discounts as dictated by departmental policies.
Utilizes all methodologies of third party payor contact [web, Real-Med, fax, etc.] for the timely resolution of unpaid claims.
Retrieves supporting documents (medical reports, authorizations, etc) as needed for review and/or submission to third-party payers. Non CPCs must have all medical records reviewed and approved by Lead Staff CPCs prior to mailing out.
Identifies and informs the supervisor / Production Unit Manager of issues, trends and/or problems associated with non-payment of claims.
Works with Claims Coordinator to resolve edits associated with unpaid, unprocessed and/or rejected claims.
Minimum Qualifications (Required)
High school diploma or equivalent required.
Minimum, one (1) year medical billing [insurance] experience required; two (2) years preferred; CPC preferred.
Knowledgeable in medical terminology and CPT/ICD coding basics.
Special Knowledge, Skills, and Abilities
Ability to utilize various billing, payor and patient information systems.
Savvy in MD payer processing rules & regulations, their respective submission guidelines and their procedures and policies for rejection and appeal processing.
Classified Title: Collection Specialist Working Title: CO Collection Specialist Role/Level/Range: ATO 40/E/02/OC Starting Hourly Pay Rate Range: $13.36 - $18.41 hr/ Commensurate with Experience Employee group: Full Time Schedule: Monday - Friday, 8:30 am - 5:00 pm / 40 hrs per week Exempt Status: Non-Exempt Location: 16-MD:JH at White Marsh Department name: 10002800-SOM DOM Billing Personnel area: School of Medicine
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