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Healthcare Insurance Recovery Specialist

2 months ago

Tomball, Texas, United States Sentido Health Full time
Job Overview

Position Summary: The Medical Collections Specialist plays a crucial role in managing the financial aspects of patient accounts, focusing on the collection of payments from insurance providers. This position requires a proactive approach to ensure maximum reimbursement from insurance claims.

Key Responsibilities:

  • Conduct follow-ups on outstanding claims and unpaid accounts, identifying and resolving billing issues efficiently.
  • Investigate claim denials and discrepancies by performing thorough research and communicating with insurance companies.
  • Utilize a comprehensive understanding of Explanation of Benefits (EOBs) to verify correct payments have been received.
  • Escalate complex issues to supervisors in a timely manner to facilitate resolution.
  • Adhere to established collections processes and maintain accurate records of collection efforts.
  • Gather clinical information as required by insurance providers.
  • Monitor assigned accounts, including adjustments and reconciliations, ensuring compliance with corporate policies and regulations.
  • Maintain effective communication with team members and management regarding collection statuses.
  • Analyze documents and correspondence to support payment resolution efforts.
  • Manage multiple tasks efficiently while providing exceptional customer service.

Performance Metrics:

  • Timely submission of appeals and corrected claims.
  • Efficient handling of incoming mail and denial resolutions.
  • Regular review of aging reports to ensure no deadlines are missed.

Preferred Qualifications:

  • Experience with Brightree software is advantageous.
  • Prior experience in Durable Medical Equipment (DME) collections is highly desirable.

Work Environment: This role may be performed in-office or remotely, depending on organizational needs.

Physical Requirements: Ability to lift and carry items up to 10 lbs.

Organizational Skills: The ideal candidate will possess strong communication skills, attention to detail, and the ability to thrive in a fast-paced environment.

Note: This job description is intended to provide a general overview of the position and is not exhaustive of all responsibilities and duties.