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Hospital AR Specialist

4 weeks ago

Dallas, Texas, United States United Surgical Partners Full time
Job Title: Hospital AR Collector

Job Summary:

We are seeking a highly skilled Hospital AR Collector to join our team at United Surgical Partners. As a key member of our revenue cycle team, you will be responsible for resolving outstanding surgical claims and ensuring maximum reimbursement for our hospital.

Responsibilities:

  • Timely follow-up and resolution on all outstanding A/R, including unpaid, underpaid, and denied claims for all payers, including self-pay.
  • Manage daily work queue to prioritize high-dollar claim balances.
  • Perform insurance claim follow-ups for insurance denials and appeals, and contact insurance companies to check eligibility and benefits via phone or online.
  • Review payers' contracts to ensure claims have processed correctly.
  • Knowledge of all payers, including MCR, MCR ADVG, Medicaid, Medicare Advantage, and Commercial payers.
  • Review and work incoming insurance and patient correspondence, including refund requests.
  • Prepare and write medical necessity appeals when appropriate or provide requested medical documentation.
  • Ability to review medical documentation to justify medical necessity.
  • Review patient balances to ensure accuracy and follow up with patients to obtain payments.
  • Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules, or summary plan documents.
  • Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCDs) for claim resolution.
  • Negotiate payment amounts for procedures with Third Party Administrators for out-of-network providers.
  • Recommend adjustments when applicable or recommend refunds for overpayments to insurance carriers or patients, providing the appropriate documentation.

Requirements:

  • 3+ years of hospital collections experience preferred.
  • Excellent communication skills and interpersonal skills.
  • Skilled in time management and prioritization of emergent situations.
  • Excellent customer service skills, demonstrating professionalism.
  • Ability to read and interpret insurance explanations of benefits and managed care contracts.
  • Knowledge or experience working with a variety of healthcare insurance payers is preferred.
  • Intermediate computer proficiency in Microsoft Office, including Excel and Outlook.
  • DDE, Ability Ease, nThrive, Cerner, Advantx, Vision, HST, Waystar experience preferred.
  • High School Diploma or equivalent.