Insurance Collection Specialist
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Job Description
Insurance collection specialist managing healthcare account follow-up, claims resolution, and denial appeals for Baptist Health. Supporting medical necessity reviews and training new collection specialists.
Responsibilities:
- Timely follow up for all assigned accounts utilizing A/R reports and account maintenance activities
- Ensure timely collection of all outstanding balances
- Utilize available resources for proper claims resolution
- Apply payer guidelines for effective denial management
- Understand and apply ICD-10, CPT-4 and associated modifiers
- Navigate different levels in the appeals process to optimize recovery efforts
- Review medical record documentation and identify documentation needed to overturn insurance denials
- Recognize resources for drug information and medical necessity terms and definitions
- Understand the components of the FDA Label
- Use compendia resources to assist in medical necessity appeals
- Assist in training new collection specialists
Requirements:
- High School, Cert, GED, Trn, Exper.
- 5 years of experience
- Experience in billing, collections and appeals
- Proficiency with MS Word and Excel
- Excellent written and verbal communication skills
- Detail-oriented and excellent problem solver
- Knowledge and understanding of medical terminology, explanation of benefits and insurance verification applications
- Knowledge and understanding of ICD-10, CPT-4 and modifiers
- Desired completion of an accredited Certified Coding Specialist program
Benefits:
- Career growth and development opportunities, with clear pathways and ongoing support
- Comprehensive health and wellness resources
- A wellness program that can help employees eliminate their medical plan deductible, reducing out-of-pocket healthcare costs
- Tuition reimbursement to support continued learning and advancement
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