Hospital Claims Collections Specialist

Employer: Change Healthcare

Overview of Position
Follow up and pursuit of unpaid hospital insurance accounts. Subsequent verbal resolution push and/or submission of written payer disputes/appeals of underpaid accounts and denials, as well as corrected claim submission. Provide complete and thorough account reviews and audit documentation, as well as perform appropriate action steps to pursue payments for account resolution.

What will be my duties and responsibilities in this job?

• Possess and apply a thorough knowledge of pursuit of insurance hospital payments.
• Note and document accounts appropriately
• Request or bill corrected claims as needed
• Review hospital/provider notes, payments, refunds, recoups, and articulate underpayment causes and denials with payers
• Review variances and take appropriate action to engage the payers to render payment
• Request and review additional hospital information as appropriate
• Learn, comprehend and navigate complex hospital systems
• Follow HIPAA guidelines in handling patient information
• Prioritize workloads using tools and resources in the most efficient manner to produce highest levels of quality productivity leading to appropriate account resolution.

What are the requirements needed for this position?

• High school diploma or GED required
• Prior experience in hospital revenue cycle billing, follow-up and reimbursement.
• Requires at least 2 years prior experience in the healthcare field, specific to understanding the drivers causing hospital claim non-payment and denials, and the follow up dispute resolution processes required by the various insurance carriers/payers to overturn and generate reimbursement.

What other skills/experience would be helpful to have?

• Excellent knowledge of insurance industry process and procedures
• Strong decision making, and problem-solving skills are needed, as well as an ability to work independently with minimal supervision.
• Understanding and knowledge of CPT-4/HCPC/DRG/ICD/HCPCs, and Revenue codes
• Enhanced knowledge of HIPAA privacy guidelines as well as maintaining and protecting all confidential information.
• Ability to multitask and set priorities on multiple projects for the highest rate of returns.
• Knowledge of Commercial, Medicare/Medicaid and Medicare/Medicaid HMO’s
• Understanding of A/R projects procedures and process, and the follow up required to drive collections
• Sorting and filtering in Excel skills required

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