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Collection Specialist, Patient Financial Services

2 months ago

Westchester, United States Midwest Orthopaedics at Rush Full time
It's the people that make the difference.Are you ready to make your impact?

Midwest Orthopaedics at Rush is nationally recognized as a leader in comprehensive orthopedic services.The Orthopedic Program at Rush University Medical Center is ranked 5th in Orthopedics by U.S. News and World Report. Founded in 2003, MOR is comprised of internationally-renowned Orthopedic and Spine surgeons who pioneer the latest advances in technology and surgical techniques to improve the lives and activity levels of patients around the world.MOR doctors are the official team physicians for the Chicago White Sox, Chicago Bulls, Chicago Fire Soccer Club and DePaul University Athletics.

Ready to Join? We are seeking a full-time Collections Specialist based of our corporate office near Oak Brook, IL with potential to be fully remote. The Collections Specialist is responsible for accurate and timely claims follow-up and accounts receivable resolution. The Collection Specialist adheres to government regulations, payor contracts, and third party guidelines when resolving open balances, resolving denials, and appealing claims. The incumbent is responsible for identifying and reporting inefficiencies and opportunities that enhance revenue flow, decrease denials, and minimize write-offs.

Key Responsibilities

  • Analyzes authorizations, claims, explanation of benefits, correspondence, payor website and/or any additional information necessary to identify the next appropriate action toward payment resolution.
  • Follows government, commercial, workers compensation, motor vehicle accident, personal injury, and/or third party payor guidelines to ensure complete and timely follow-up on open balances for assigned payors or accounts.
  • Performs appeals, underpayment appeals, and disputes by following government, commercial, and third party payor appeals guidelines or contracted terms. Utilizes payor contracts and fee schedules to perform underpayment appeals or collaborates with the practice to obtain medical necessity appeals documentation. Assists with tracking appeals outcomes.
  • Contacts patients or appropriate payor representatives via phone or electronically to resolve claims and/or coordinate benefits and submits claim in the correct filing order. Works to identify other payors when possible and ensures all payors and filing order is correct in the practice management system.
  • Collaborates with the Revenue Cycle Analyst to identify patterns and interpret denial trends. Notifies Manager when insurance plans deny services, which are covered based on the contract terms, government regulations, third party agreement or patient's benefit plan.
  • Works to minimize write-offs by exhausting all resolution options and performing thorough research/review of all appropriate resources. Adjusts account or requests write- offs adhering to MOR policies and procedures.
  • Reviews denial reports and makes recommendations for billing or claim submission changes based on claim denials.
  • Researches payor and government websites and/or medical resources, to identify payor claim requirements required to resolve open accounts receivable.
  • Collaborates with Coding Team or physician to resolve coding related denials and submits all coding related corrected claims and/or appeals.
  • Targets and reports any internal procedures or processes that may negatively impact or increase days in accounts receivable or delay claims resolution.
  • Interacts with patients, government payors, and third party payors to respond to billing requests as appropriate.
  • Assists call center representatives with physician practice or patient requests by providing claim information and/or claim status to call center representative to correctly respond to patients
  • Meets productivity and quality standards.
  • Documents using standardized note format all payor, attorney, and/or third party follow-up and account resolution activities in the practice management system
  • Remains current with trends, regulatory requirements, and business strategies related to the revenue cycle
  • Operates in compliance with all local, state and Federal laws as well as Company policy and compliance standards
  • Other duties and responsibilities as assigned
Education and/or Experience
  • High School Diploma or equivalent; Associates or Bachelor's Degree preferred
  • 3- 4 years of related experience in a business office or on a revenue cycle team; Preference given for physician or medical group CMS 1500 experience
  • Strong expertise with Cigna and Humana claims submission, denial resolution, and appeals processes.
  • Knowledge of durable medical equipment requirements
  • Understanding of workers compensation, motor vehicle, and personal injury claims
  • Experienced with patient accounting systems - Athena preferred
  • Medical terminology required for accurate claims processing
  • Knowledge of CPT, HCPCS, and ICD coding systems
Skills
  • Ability to interpret and apply government and third party payor billing guidelines, claim rules, and managed care contract terms
  • Detail oriented with a high level of problem solving skills
  • Ability to work effectively within designated timeframes
  • Ability to collaborate and work cohesively as part of a team
  • Experience working in revenue cycle applications to resolve patient accounts
  • Communicates effectively orally and in writing
  • Experience with Word and Excel
Certificates, Licenses, Registrations
  • RHIA or RHIT preferred


Our employees make the difference in our patients' lives, and we value their contributions. Midwest Orthopaedics at Rush offers a comprehensive compensation and benefits package and an opportunity to grow and develop your career with an industry leader. Come see what we're all about. Equal Opportunity Employer.