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Medical Collections Specialist

The Medical Collections Specialist achieves timely collection (payment) of outstanding hospital claim balances related to claim underpayments or denials. Collections may be related to appeals or grievances filed with health insurance plans/payors, corrected claims, assigned account balances, or other payment barriers. The position is responsible for the timely and complete collection of outstanding hospital insurance balances. This is achieved by following appropriate guidelines for billing, coding, collection, payment posting and customer service. Collection is achieved through follow up and coordination with individual insurance plans and their provider appeals and grievances departments.

Collection Targets

  • Maintain collection aging targets per client goals and Titan policy – strive for collection within 45 days of initial activity.
  • Maintain collection action/activity/frequency targets per client requirements and Titan policy.

Collection

  • Data entry and tracking of follow-up and payment information into Titan and Client claims system
  • Notation of Titan and Client claims systems on progressive activity.
  • Timely collection of outstanding appeals/grievances,
  • Consistent/timely follow-up by phone with the appropriate health insurance plan on each short pay or denial.
  • Collection includes appeal logic arguments based on written appeal logic as presented by the Auditor.
  • Assist with submission of appeal letters to the insurance plan/payor.
  • Identify and submit materials required by the insurance plan/payor for resolution of the appeal/grievance.
  • Identify and resolve denials, including escalation appeals to higher level as appropriate.
  • Identify payments, including assistance with Client-specific invoice processes where required.
  • Perform progressive action on every contact with an account, ensure that every time an account is worked the collection moves forward.

Quality

  • Meet or exceed production and quality standards as defined by Titan and hospital client.

Administrative

  • Clerical or administrative duties as assigned.
  • Perform other duties as assigned.

Professional

  • Maintain professional and technical knowledge by attending educational workshops, reviewing professional and technical publications, maintaining certifications.
  • Contribute to overall team process and outcome improvement.
  • Foster professional and respectful relationships with internal and external customers, co-workers, and staff.
  • Perform other duties as assigned.

To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education · High School Diploma or equivalent.

Experience

  • Hospital billing experience preferred
  • Hospital coding experience, certification preferred
  • Customer and Client services experience
  • Excellent oral and written communication skills
  • Accurate in data entry
  • Working knowledge of computer skills and Microsoft Windows/Word/Excel
  • Working knowledge of Commercial, Medicare and Medicaid billing and claims
  • Professional in both appearance and attitude

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical Activities - While performing the duties of this job, the employee is regularly required to reach with hands and arms and talk or hear. The employee is frequently required to sit. The employee is occasionally required to stand and walk.

Weight Lifted/Force Exerted - Lifting of minimal weight (<20lbs) may be occasionally required. Assistance can be provided as necessary.

Vision Requirements - Specific vision abilities required by this job include close vision and the ability to adjust focus.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Environment Conditions - While performing the duties of this job, the employee does not work in wet or humid conditions (non-weather), work near moving mechanical parts, work in high, precarious places, endure outdoor weather conditions, endure extreme cold or heat (non-weather), or is at risk of electrical shock.

 Noise Level - The noise level in the employee's work environment is usually quiet to moderate.

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