Spartanburg Regional Healthcare System

Manage and collect accounts receivables, perform claims follow-up, resolve payment issues, update insurance records, and produce reports to meet departmental AR goals. | High school diploma, 3+ years medical billing/collections experience, knowledge of CPT, HCPCS, ICD-9/10 codes, EOB and remittance codes, Microsoft Office proficiency, and good communication skills. | Job Requirements Position Summary The Collections Specialist is responsible for managing and collecting on accounts receivables for all insurance carrier plan services billed through the hospital/physician billing systems. This position is responsible for timely and accurate claims follow up and payer corrections to meet and exceed our departmental cash collection and AR goals. Minimum Requirements Education • Highs School Diploma or equivalent Experience • 3+ years medical office or medical billing/collections experience in a hospital or centralized billing setting. • Must possess knowledge of CPT, HCPCS, and ICD-9/10 codes. • Must have a good working knowledge with insurance explanation of benefits (EOB) and comprehensive understanding of remittance and remark codes. • Be familiar with multiple payer requirements for claims processing • Solid skills with Microsoft office with a focus on Excel and Word. • Good Communication Skills License/Registration/Certifications • N/A Preferred Requirements Preferred Education • Associates degree Preferred Experience • 4+ years’ experience in a centralized billing setting. • Possess an in-depth working knowledge and experience with all types of insurance billing guidelines: Commercial, Medicare Part A and B, Medicaid, Managed Care plans etc. • Experience with multiple specialty billing, collections, and denials Core Job Responsibilities • Collections of all outstanding claims by direct payer contact, utilization of payer websites, and EDI/Claims system • Research and resolve all payments issues/errors for insurance balances • Responsible to complete all error corrections and insurance updates to the facility/professional claim to resolve issues preventing payment • Ability to obtain insurance eligibility and benefit information from payers via phone, RTE, or web for proper claims filing • Review smart edits and payer rejections and perform all necessary rework for reimbursement of services • Must possess the ability to work in different systems including claims eligibility, online payer claims system, as well as all AR management systems • Escalating non-denial payer issues, including review of outstanding AR greater than 90 days, and sharing details with payers and management • Work closely with multiple departments to obtain necessary information to resolve outstanding AR • Update and verify insurance records as needed to correct outstanding accounts • Responsible for ensuring claim has been received and is processing with payer within the timely filing period as defined by departmental goals and insurance guidelines • Ability to present trends and issues to payers during monthly provider calls • Gather information from payers to submit payment research requests when payment is not posted to an account • Produce reports and data in Excel as needed • Must have working knowledge of registration, payment posting, error correction and other billing functions • Exhibit professionalism and good customer service skills • Ability to maintain confidentiality and handle sensitive information • Responsible for responding to emails within 24/48-hour turnaround time from receipt • Responsible for utilization of time and management of work processes to ensure organizational and departmental expectations are met • Other duties as assigned.

Manage denial and accounts receivable processes including researching denials, managing appeals, identifying trends, and communicating with supervisors. | 4 years medical billing experience with exposure to denials and appeals, knowledge of ICD9/CPT-4 coding, insurance EOBs, and strong Microsoft Office skills. | Job Requirements Position Summary The Denial Management Specialist is responsible for denial and AR management for the department as defined by their supervisor/manager. Minimum Requirements Education • High School Diploma or equivalency Experience • 4 years' experience in medical billing, setting with exposure to denials, appeals, insurance collections and related follow-up. • Must have good knowledge of ICD9 and CPT-4 coding • Must have a good working knowledge with insurance explanation of benefits (EOB) and comprehensive understanding of remittance and remark codes. • Be familiar with multiple payer requirements for claims processing • Solid skills with Microsoft office with a focus on Excel and Word. • Good Communication Skills License/Registration/Certifications • N/A Preferred Requirements Preferred Education • Associates or Bachelor's degree in a Healthcare related field. Preferred Experience • Focused denials and appeals management experience. Preferred License/Registration/Certifications • CPC and/or CPC-H certification Core Job Responsibilities • Research and resolve all outstanding denials within workque and complete all necessary follow up within a timely and accurate manner • Identify all denial trends and provide education of steps to prevent future avoidable denials. • Initiate/manage all insurance appeals in a timely manner • Manage outstanding AR related to denials. • Communicate all denial trends and denial increases to direct supervisor/manager in order to positively affect the volume of denials • Organize the workflow to ensure that denials are worked according to departmental policy and standards. • Manage correspondences and any ADR requests as defined within department workflow procedure to ensure timeless and accuracy of response. • Complete special projects as assigned by Supervisor/Manager • Prepare/attend AR denial meetings as required.