Escalations Resolution Specialist

2 weeks ago

Tampa, Florida, United States CarepathRx Full time
Job Title: Escalations Collections Specialist

CarepathRx is seeking a dedicated and detail-oriented Escalations Collections Specialist to join our Revenue Cycle Team. In this role, you will be responsible for resolving escalation requests for the collections of insurance claims.

Key Responsibilities:
  • Ensure the timeliness and accuracy of escalation requests and resolution
  • Understand Third Party Billing and Collection Guidelines
  • Identify root cause of issues and demonstrate the ability to recommend corrective action steps to eliminate future occurrences of denials
  • Meet quality assurance, benchmark standards and maintain productivity levels as defined by management
  • Reviews patient information in the appropriate system to determine why the claim is unpaid, if an adjustment is valid and whether additional approval is required
  • Reviews rejections and denials to determine if the claim needs to be refiled or submitted for an appeal with the payer
  • Process all Payer appeal requests within the time frame required by the Payer
  • Processes all approved adjustments
  • Able to identify errors, correct claims and reprocess for reimbursement
  • Contacts payer, or patient as appropriate
  • Documents all collections activity in patient collections notes
  • Able to read and interpret an EOB for accurate understanding of denial
  • Understand Patient level benefits
  • Some knowledge of copay assistance programs and foundation programs
  • Knows how to investigate claims, and reimbursement contracts
Requirements:
  • Background investigation (company-wide)
  • Drug screen (when applicable for the position)
  • Valid driver's license in state of residence with a clean driving record (when applicable for the position)
  • High school graduate or equivalent
  • Excellent interpersonal, organizational, communication and effective problem-solving skills are necessary
  • High school diploma or GED equivalent
  • One to three years of related prior work experience in a team-oriented environment
  • Experience in medical field and administrative record management
Preferred Qualifications:
  • Strong customer service background
  • Ability to communicate with patients, payors, outside agencies, and public through telephone, electronic and written correspondence
  • Effectively communicate in English; both oral and written, with physicians, location employees and patients to ensure questions and concerns are processed in a timely manner
  • Helpful, knowledgeable, and polite while maintaining a positive attitude
  • Interpret a variety of instructions in a variety of communication mediums
  • Knowledge of Home Infusion
  • Knowledge of insurance policies and requirements
  • Knowledge of medical billing practices and of billing reimbursement
  • Maintain confidentiality and practice discretion and caution when handling sensitive information
  • Multi-task along with attention to detail
  • Must be able to accurately perform simple mathematical calculations using addition, subtraction, multiplication, and division
  • Self-motivation, organized, time-management and deductive problem-solving skills
  • Work independently and as part of a team
  • Collections or medical billing experience with basic understanding of ICD9, CPT4, HCPCS, and medical terminology is preferred
  • Familiarity with third-party payor guidelines and reimbursement practices and available financial resources for payment of balances due is beneficial
  • Medicare knowledge of billing requirements specific to DMEMAC HCN360 and CPR+ knowledge preferred

CarepathRx provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment.

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