Medical Insurance Collections Specialist

3 weeks ago


Dallas, Texas, United States Prism Health North Texas Full time
Job Summary

Prism Health North Texas is seeking a highly skilled Medical Insurance Collections Specialist to join our team. As a key member of our revenue cycle team, you will be responsible for collecting payments from third-party medical, dental, and behavioral health payors. This includes denial research, preparing and submitting appeals, and following up on unpaid, partial paid, or incorrectly paid claims.

Key Responsibilities
  • Monitor claims status for prompt and accurate payment, and follow up on, correct, and/or re-submit rejected, denied, partially paid, and incorrectly paid medical, dental, and behavioral health claims to insurance carriers in a timely manner.
  • Respond to payor correspondence, secure and submit additional documentation required or requested by insurance carriers.
  • Identify coding, billing, and/or payment errors from EOB/ERA and make indicated corrections.
  • Identify consistent payer delays, systematic denials, and other patterns and communicate them to management.
  • Demonstrate and apply thorough understanding of insurance plan, Medicare, and Medicaid contracted rates, terms, and regulations to identify inaccurate payments and/or adjustments.
  • Investigate, analyze, and resolve denials from insurance carriers.
  • Understand and analyze EOB/ERA information, including co-pay, deductible, co-insurance, coordination of benefits, contractual adjustments, denials, etc. to verify accuracy of insurance payments and patient balances.
  • Post charges, payments, adjustments, etc., as assigned.
  • Maintain current knowledge on insurance carrier billing requirements and changes.
  • Accurately and timely update insurance, payment, and claim activity information in EHR/billing system.
  • Collaborate effectively with patients, providers, and staff as needed to obtain needed information and to continually improve organizational billing and collections performance.
Requirements
  • Detail-oriented, independent critical thinking and problem-solving skills.
  • Demonstrated ability to handle multiple responsibilities and meet tight deadlines in a complex environment.
  • Demonstrated knowledge of medical, dental, and/or behavioral health provider reimbursement, medical terminology, ICD-10, CPT, and HCPCS coding.
  • Proficiency in MS Word, Excel, and Outlook. Experience with MS Teams preferred.
  • Excellent written and oral communication skills.
  • Excellent technical and business acumen.
Education and Experience
  • High school or equivalent education required. Associate's degree, Medical Assistant training, or other relevant certificates, certifications, or post-secondary education preferred.
  • Minimum of 3 years' experience in medical collections (medical, dental, and/or behavioral health); billing; coding; and/or denials management required.
  • Medical and/or Dental Coding Certification required.


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