Claims Recovery Collector - Della Infotech : Job Details

Jo Details: • Review and analyze delinquent accounts receivable, identify outstanding insurance claims, and determine appropriate action steps for recovery. • Initiate contact with insurance companies via phone, email, portals, or written correspondence to discuss outstanding claims and negotiate payment. • Follow up with insurance carriers to obtain claim status updates, investigate reasons for non-payment, and request additional documentation if required. • Maintain accurate and up-to-date records of all communication and activities related to claim recovery efforts. Ensure proper documentation of payment status, promises to pay, and any other relevant information. • Engage in negotiation discussions with insurance companies to secure timely payment of outstanding claims. Utilize persuasive and assertive communication techniques to maximize recovery. • Prepare and submit appeals for denied claims, providing supporting documentation and medical records as necessary. Advocate for claim acceptance and escalate appeals as appropriate. • Identify and resolve issues or discrepancies that may impede the collection process, such as claim processing errors, incorrect billing codes, or missing information. Collaborate with internal departments, to address and resolve such issues. • Adhere to legal and regulatory requirements governing claims recovery activities, including HIPAA, Fair Debt Collection Practices Act (FDCPA), and any applicable state and federal regulations. • Consistently meet or exceed daily KPIs in connection with claim recovery activities, including collection, and performance. • Report any challenges faced during the process and provide updates to management on progress and recommendations for improvement. • Provide excellent customer service to internal stakeholders, such as teammates and providers, by promptly addressing their inquiries, concerns, and requests for information related to claim recovery efforts. Confer with Physicians/Providers by telephone, fax and email inquiries regarding outstanding third-party recovery, as appropriate. • Communicate with claims representatives for commercial carriers by telephone, fax and email to determine claim status and create claim-level appeals. • Leverage RCM knowledge to assess denials, pursue appeals or close claims when appropriate. • Pursue each outstanding account to reach appropriate reimbursement by working with subject matter experts to resolve challenging claims. • Work with document imaging system for archival purposes. Non-Essential Responsibilities • Performs other functions as assigned Knowledge, Skills and Abilities • Strong understanding of third-party billing and/or claims processing. • Ability to use critical thinking skills. • Possess good customer service skills. • Ability to adapt to change. • Ability to manage time effectively and multi-task. • Ability to work independently, prioritize tasks, and meet deadlines. • Ability to perform basic mathematic calculations. • Ability to work proficiently with Microsoft Windows, Word and have basic knowledge of Excel. • Average manual dexterity in use of a PC, phone, sorting, filing and other office machines. • Ability to be detail oriented. • Ability to learn and follow HIPAA privacy and Security rules. • Ability to work independently to meet predefined production and quality standards. • Ability to perform well in a team environment to achieve business goals. Work Conditions and Physical Demands • Primarily sedentary work in a general office environment • Attention to detail and accuracy in recordkeeping and documentation. • Strong interpersonal skills and the ability to work collaboratively with internal teams and external stakeholders. • Demonstrated resilience, persistence, and a results-oriented mindset. • Familiarity with basic computer usage and applications • Ability to communicate and exchange information • Ability to comprehend and interpret documents and data • Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.) • Requires manual dexterity to use computer, telephone and peripherals • May be required to work extended hours for special business needs Minimum Education • High School Diploma or equivalent required. • Some college coursework (with concentration in healthcare, medical billing or coding field) or a degree in a related field is preferred. Certifications (Required/Desired) None Minimum Related Work Experience • One - Two years of claims-related experience or prior experience in healthcare claims recovery, medical billing, or collections is advantageous. • Familiarity with medical billing and coding terminology, CPT and ICD-10 codes, and claim submission processes. • Preferred experience handling and interpreting medical records, EOB's, and standard health industry claim billing forms Knowledge of insurance reimbursement practices, including claim payment guidelines, denial codes, and appeals processes. • Excellent communication and negotiation skills, with the ability to assertively pursue payment while maintaining professional relationships. • Strong problem-solving and critical-thinking abilities to analyze claim issues and identify appropriate solutions. • Proficiency in using computer systems, including billing software, spreadsheets, and databases. Associated Reference Job Field (For HR use only)