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Description A Healthcare Laboratory company is in the need of a remote Medical Billing Collections Specialist. The Medical Billing Collections Specialist will be responsible for performing collections and medical billing for various regional and national payers, including Federal, State, Third Party (HMO, PPO, IPA, TPA Indemnity) and Patient Billing. The Medical Billing Collections Specialist must possess detailed knowledge of all medical benefit levels and a have a thorough understanding of Federal, State, PPO, HMO, and Indemnity Plans structure.

Essential Duties and Responsibilities

• Reviewing patient statements and working closely with patients to collect on open balances.

• Data entry, correct insurance assignment to patient accounts, insurance eligibility verification. Review/update demographics and patient information for accuracy.

• Working knowledge of appropriate coding systems; CPT, ICD-10 and HCPCS, coverage; LCD/NCD and reimbursement associated with such codes.

• Processing, validation of payer requests and processed claims via correspondence, remittance advice and EOBs (i.e., identification of payment discrepancies, inappropriate requests)

• Investigate all denied services to determine the reason for the service denial, appeal, if appropriate. Identify and report root causes associated with denials.

• Timely, effective processing of assigned appeals including development, submission, tracking, reporting and evaluation of appeal outcomes (i.e., next steps, improved outcomes)

• Maximize utilization of Billing system, tools, and resources to support cash collection activities.

• Review and work various reports including aging, adjustments, and credit balances.

• Comply with Federal and State legislation pertaining to all billing related matters.

• Support and maintain department cash and DSO goals. Requirements Medical Collections, Medical Billing, Medical Appeals, Medical Denials, Laboratory experience, Pathology, HMO PPO, Medicare

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