Employment Type:

Full time

Shift:

Description:

Collections Specialist

Loyola Medicine, treating the whole person with compassion—to "also treat the human spirit." The Collections Billing Department- seeks a Collection Specialist to ensure accurate and timely insurance and self-pay follow-up of payments due for Loyola University Medical Center physician services.

Shift 7:00am-3:30 M-F no Weekend

Job Summary:

In this role, the Collection Specialist ensures accurate and timely insurance and self-pay follow-up of payments due for Loyola University Medical Center physician services. The Specialist contacts government and third party payers to re-submit insurance claims, appeal denied claims, make payment arrangements, and processes unpaid claims until resolution. Initiates contact with patients to coordinate benefits, make self-pay arrangements or initiate Medicaid and/or charity care applications. The Specialist strives to minimize write offs and maximize collections by prioritizing work and maintaining productivity and quality standards.

Position Responsibilities:

• DENIALS - Prioritizes and manages time efficiently to complete assigned work queues and special projects. Performs complete and timely follow-up on claims that have been rejected or denied by the insurance carrier until the invoice is resolved to a zero balance. Meets productivity and quality standards by accurately appealing denied claims. Performs appeals and reviews according to assigned payors following correct claim appeal guidelines. Works to collect outstanding insurance balances and identifies other payors where possible. Contacts patients or insurance representatives via phone or computer system to coordinate benefits. Notifies Manager when insurance plans deny or challenge medical necessity of services and coordinates with the Coding Team to obtain letters of medical necessity and feedback on coding related denials. Works to minimize write-offs by adhering to write off standards and policies. Requests write- offs as necessary after thorough research and review of the invoice/account has been completed. Documents collection activities in the physician billing system. Follows correct notation format and utilizes standard abbreviations when placing notes in Epic and IDX. Completes note in Epic and IDX identifying the invoice, the name of the insurance rep, the reason why the claim denied – (specifying the cpt code or diagnosis code as necessary) and action taken on the invoice/account.
• UNRESOLVED ACCOUNTS RECEIVABLE - Prioritizes and manages time efficiently to meet productivity and quality standards by accurately processing un-resolved accounts as assigned. Updates Epic registration and rebills claims in Epic and/or IDX as needed. Initiates contact with patients to coordinate benefits, make self-pay arrangements or initiate Medicaid and/or charity care applications. Applies self-pay discounts when necessary after thorough review of the invoice/account. Reviews invoices/accounts in self-pay that are pending agency placement and verifies if placement should occur. Corresponds with eligibility reps at the hospital to verify if patient has alternative payment source. Sets follow-up ticklers in IDX and Epic when rebilling claims to ensure all claims are processed. Follows correct notation format and utilizes standard abbreviations when placing notes in Epic and IDX. Completes notes in Epic and IDX identifying the invoice, name of the insurance rep, and status on the claim.
• BILLING – Bills secondary balances where appropriate to correct payer or transfers to patient responsibility. Follows secondary payor guidelines to submit claim accurately. Clears TES edits, edits in eCare and claim form edits in IDX as necessary and bills claim.
• DENIAL MANAGEMENT – Identifies trends and issues within the work queues/work files. Communicates trending issues encountered to the Team Lead or Supervisor. Makes recommendations for TES/charge review rule modifications and additions based on claim denials.
• CASH APPLICATIONS AND CREDIT BALANCES – Assists the Cash Application Specialists as needed to post cash timely or provides assistance with insurance and patient refunds as assigned.
• PROFESSIONAL DEVELOPMENT - Successfully completes training on the collection, cash posting, self-pay and registration process for Epic and/or IDX. Maintains registration, cash posting, self pay, billing, and insurance follow-up expertise required to perform successfully in the role. Becomes familiar with payor specific processes. Performs all other duties as assigned.

Magis & Service Excellence Accountabilities:

• Responsible for consistently demonstrating our Magis values of Care, Concern, Respect and Cooperation through teamwork and effective communication in an effort to prevent and solve problems and to achieve quality outcomes, patient safety, customer satisfaction and a safe environment.
• Responsible for developing and maintaining an environment of service excellence as outlined in the Service Excellence standards.

Position Requirements

Minimum Requirements:

• Administrative or technical background acquired through completion of 2 - 3 years of college
• 3-5 years of previous job-related experience
• Details: Prior experience in accounts receivable, insurance denial management, or insurance follow-up in a physician billing office required.

Preferred:

• Associates Degree
• 6-10 years of previous job-related experience

Required Skills:

• Ability to analyze and interpret data
• Ability to communicate verbally
• Ability to compose letters and memorandums
• Ability to deal calmly and courteously with people
• Ability to deal with stressful situations
• Ability to finish tasks in a timely manner
• Ability to follow oral and written instructions and established procedures
• Ability to function independently and manage own time and work tasks
• Ability to maintain accuracy and consistency
• Ability to maintain confidentiality
• Ability to maintain office files and follow standard office procedures
• Ability to organize workflow
• Ability to perform basic filing, office procedures and word processing
• Ability to work as an effective team member
• Other: Detail oriented and ability to accurately perform work assigned in accordance with policies and procedures required. Ability to continually demonstrate collaborative and team oriented behavior.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.