Blue Cross Blue Shield Out-of-Network Insurance Commercial Collector

Job Summary:

The collection specialist is responsible for ensuring accurate billing, timely submission of electronic and/or paper claims along with appeals, monitoring claim status, researching rejections and denials, documenting related account activities, ensure posting adjustments and payments are correctly posted. The collection specialist must possess critical thinking skills and understanding of out-of-network commercial healthcare claims, insurance payor methods, and denial remark codes. In addition, the commercial collection specialist must demonstrate proficiency with billing system to ensure all functionality is utilized for the utmost efficient processing of claims.

Responsibilities:

Commercial Collection Specialists are responsible for all functions related to the collection of payment on patient accounts/claims. This role requires strong communication skills, attention to detail, and a deep understanding of the unique challenges associated with front end processes, billing and AR collections.

• Review all outstanding claims listed in a work queue and respond to mail, telephone calls, electronic correspondence received.
• Comply with all timely filing deadlines for all insurance payers
• Perform insurance claim follow-ups for insurance denials and appeals
• Research, record findings, identify trends, and carrier issues relating to billing and reimbursements. Report findings to management
• Contact insurance companies to check claim status, appeal status via phone or online portals
• Assist with other collection duties, as needed per management.

Requirements:

• Medical Revenue Cycle and AR Collections: Out of Network Collections including Insurance Verifications, Billing and Posting – 5yrs. minimum (Required). Experience with BCBS denials and how they process Out-Of-Network claims is a must-have.
• This role requires strong communication skills – written and verbally, must be detail oriented, organized with the ability to multi-task and in a busy office environment, proficient customer service, and a deep understanding of the unique challenges associated with front end processes of the revenue cycle management.
• Claims Follow-up: Proactively follow up with insurance companies and other payers to ensure timely resolution of unpaid claims, with a focus on Senate Bill-2476 processes.
• Denial Management: Analyze and address claim denials, rejections, and underpayments related to non-emergent and emergent transports, ensuring accurate resubmission or appeal processes.
• Patient Account Management: Review and manage patient accounts, including and verifying insurance coverage, coordinating patients outstanding balances.
• Documentation: Maintain detailed and accurate records of all follow-up activities, payer communications and claim statuses in the billing management system.
• Compliance: Ensure all activities comply with relevant regulations, payer guidelines, and company policies.
• Collaboration: Work closely with the revenue cycle team and Director of AR Revenue resolve issues and improve the overall revenue cycle processes.
• Must possess knowledge of Explanation of Benefits (EOB's) and understanding of copays, coinsurance, deductibles and denial codes.
• Maintain patient confidence and protects medical office operations by keeping patient information confidential.
• Collaboration: Work closely with the revenue cycle team and Director of AR Revenue Cycle to resolve issues and improve the overall revenue cycle processes.
• Must possess knowledge of Explanation of Benefits (EOB's) and understanding of copays, coinsurance, deductibles and denial codes.
• Maintain patient confidence and protects medical office operations by keeping patient information confidential.

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance
• 401k (matching)

Schedule:

Monday to Friday (Flexible) – 40hrs weekly

Job Type: Full-time

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Ability to Relocate:

• Spring, TX 77388: Relocate before starting work (Required)

Work Location: In person