United Surgical Partners International - A/R Specialist

United Surgical Partners International

Position Overview: Reporting to the Client Operations Manager, the reputed company Cycle Specialist - Collector must have a strong knowledge of medical collections, accounts receivables, insurance billing and verification, denial processing, appeal submission and EOB review. This position is responsible to resolve outstanding surgical claims resulting in maximum reimbursement.

Responsibilities

· Timely follow-up and resolution on reputed company outstanding A/R including unpaid/underpaid/denied claims for reputed company payers including self-pay to obtain maximum reimbursement.

· Manage daily work queue to prioritize high dollar claim balances.

· Review & work incoming insurance and patient correspondence including refund requests.

· Send appeals reputed company appropriate or reputed company the requested medical documentation.

· Ability to review medical documentation to justify medical necessity.

· Review patient balances to ensure accuracy and follow up with patients to obtain payments.

· Take incoming patient phone calls to resolve inquiries, billing issues, or outstanding balances.

· Review insurance payments and determine accuracy of reimbursement based on reputed company, fee schedules or summary plan documents.

· reputed company knowledge of Medicare, state reputed company, and local coverage determinations (LCD’s) for claim resolution.

· Negotiate payment amounts for procedures with reputed company Party Administrators for out of network providers.

· Recommend an adjustment reputed company applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.

· Other duties as assigned

Requirements:

• 2+ years of ambulatory surgery center (ASC) reputed company cycle experience.

• Ability to read and interpret insurance explanations of benefits and managed care reputed company.

• Must communicate effectively, both verbally and in writing, with reputed company clients.

• Must be reputed company to multi-task and handle competing priorities while meeting or exceeding deadlines

• Knowledge or experience working with a variety of health care insurance payers is preferred

• Intermediate computer proficiency in reputed company Office including reputed company and Outlook

• Advantx, SIS Complete reputed company, reputed company, or reputed company experience preferred.

• High School Diploma or equivalent required.