Medical Insurance Collections Associate

Medical Insurance Collections Associate

Requirements

• High School Diploma or equivalent required.
• Computer skills that include a combination of experience in a Windows Operating System, e-mail, and data entry experience.
• Three to five years in insurance billing required.
• Excellent judgment, dependability, and conscientiousness.
• Demonstrated high ethical standards and integrity.
• Demonstrated attention to detail.
• Demonstrated accuracy and thoroughness; monitors own work to ensure quality.
• Customer and patient service orientation: prompt response to patient needs and ability to manage difficult or emotional customer situations with tact, empathy and diplomacy.
• Ability to work cooperatively in group situations; offers assistance and support to coworkers, actively resolves conflicts, inspires trust of others, and treats patients and coworkers with respect.
• Patient centered care focused, and a team player.
• Handles multiple tasks effectively and efficiently and exhibits commitment to effective problem-solving techniques when issues arise.
• Continuously acts to maintain a safe, clean, healthy, and fun work environment consistent with AVP’s Mission and Vison.
• Arrives on time, ready to work, and demonstrates minimal absenteeism.
• Demonstrates effective problem-solving skills
• Knowledgeable of Medicare and Medicaid billing and reimbursement concepts and principles.
• Willingness to submit to a background check.

Responsibilities

• Enter information necessary for insurance claims such as patient insurance ID, diagnosis and treatment codes and modifiers and provider information. Insures that claim information is concise, complete, and accurate.
• Submits insurance claims to clearinghouses or individual insurance companies electronically or via paper CMS-1500 form.
• Answers patient questions on patient responsible balances, copays, deductibles, write-offs, etc. Resolves patient complaints or explains why certain services are not covered while demonstrating positive customer relationship skills with all telephone encounters.
• Follows up with insurance companies on unpaid or rejected claims. Resolves issues and re-submits claims.
• Prepares appeal letters to insurance carriers when not in agreement with claim denial. Collects necessary information to accompany appeal.
• Follows up on past due patient balances and provides necessary information to collection agencies for delinquent accounts.
• May perform “soft” collections for patient past due accounts. This may include contacting and notifying patients via phone or mail.
• Prepares and submits secondary claims upon processing by primary insurer.
• Posts insurance and patient payments using medical claim billing software as needed.
• Understands managed care authorizations and limits to coverage such as number of visits.
• Verifies patient benefits eligibility and coverage.
• Meet outlined AVP benchmarks and/or quality indicators as monitored through audits or recordings.
• Meets the expectations of our internal and external customers in providing excellent service.
• Supports organizational changes. Demonstrates flexibility in providing coverage and/or availability for the insurance department via scheduling adjustments for unexpected absences, events, or work volume variances.
• Processes Patient and Insurance Carrier refunds.
• Other duties and special projects that are assigned by management.
• Follows HIPAA guidelines in handling patient information.

Preferred Qualifications

• Prior experience with medical billing software is preferred but not required.