Tennessee Orthopaedic Alliance

Insurance Collections Specialist

US-TN-Nashville
1 month ago
Job ID
2017-1111
# of Openings
1
Category
Central Business Office

Overview

The Insurance Collections Specialist is an essential part of the TOA Central Business Office, our operation that focuses on revenue cycle excellence. As an Insurance Collections Specialist, you will use your analytical, financial, and customer service skills to ensure that the accounts of our TOA patients are accurate and reconciled in a timely fashion. Essentially, you’ll be working to make sure that TOA claims filed to an insurance payer are processed accurately and timely.   This position reports to our Assistant Director of Revenue Cycle, and is located at our Central Business Office location.

Responsibilities

The Insurance Collections Specialist focuses on reviewing patient accounts, promptly identifying any errors or other issues in claims processing, effectively following up on any unpaid balances, and expeditiously bringing any remaining balance to resolution.

  • Meets quality assurance and productivity standards by identifying, reconciling insurance balance accounts and reviewing explanations of benefits details on denials.
  • Identifies denial trends and provides potential solutions while analyzing patient accounts utilizing our EPM system – Nextgen to determine appropriate action.

  • Communicates with insurance payer representatives, patients, and TOA staff to ensure timely and accurate resolution of account transactions. This would include Commercial plans, Medicare/Medicare HMO plans, Medicaid/Medicaid HMO plans and BCBSTN.

  • Prioritizes assigned accounts to maximize aged accounts receivable resolution

  • Reviews explanation of benefit (EOB) documentation and notate accounts on collection activity to perform account resolution

  • Operates within established guidelines and protocols, including providing backup documentation for our accounting and audit functions

Qualifications

At TOA, our patients deserve the best care, and that extends beyond the clinic to include how we handle our business administration activities.

  • College is preferred, and a high school diploma or equivalent is required.
  • At least 3 years insurance collections experience is preferred, with some experience in an orthopaedic practice a plus
  • Exceptional customer service and patient focus. Our Insurance Collections Specialists often speak with our patients, providers, and payors, and it is essential that they are able to make each encounter as positive as possible.
  • Knowledge of Insurance – particularly coordination of benefit rules and denial overturns are essential to this position.
  • Knowledge of administrative and clerical procedures, including experience with computer systems/Excel. Experience with an EHR or NextGen is a plus
  • Accustomed to using mostly payer websites for appeals/reconsiderations, medical records attachments, verification of benefits and/or web-based claims follow up
  • Collaboration, working closely with Central Business Office and clinical colleagues and administrative team mates to develop a cohesive, high performing team
  • An energetic and enthusiastic pace at work, with the ability to swiftly and accurately manage the flow documents through our EHR, without any diminishing focus on accuracy
  • Dependability, with a reliance on the capacity to be at work on-time, every day so our patients can receive the administrative support they need in a timely manner

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