Collections & VOB Specialist

Description

JOB SUMMARY

This position is responsible for obtain eligibility information, obtaining pre-authorizations, and maximizing collections and minimizing outstanding accounts receivable aging percentages by performing collection functions.

ESSENTIAL JOB FUNCTIONS

•        Verifies patient insurance eligibility and benefits using an of the automated systems, web-based utilities, and phone verification directly with the payor.
•        Performing prior authorizations as required by payor source, including procurement of needed documentation by collaborating with providers and insurance companies.
•       Contacting insurance carriers per patient, to ensure proper coordination and reimbursement of benefit        Updates, edits, and confirms accurate financial account information on each patient record.
•        Speak to clients/ patients about insurance benefits and financial obligations
• Ensure accurate and complete account follow-up.
• Resolve claim processing issues in a timely manner, evaluating problem claims to the appropriate managerial personnel with the insurance carrier’s organization to quickly resolve delinquent claims or contacting patient or third-party payers in compliance with established policies and procedures.
• Review assigned claims working within the established standards, for timely follow-up maintaining and updating all patient accounts to reflect current information.
• Assess each account for balance accuracy, payer plan and financial class accuracy, billing accuracy, denials, insurance requests, making any necessary adjustments, documenting appropriately and submitting corrections or request for processing in a timely manner.
• Resolve claim processing issues on a timely basis by reviewing claim inventories, payments and adjustments and taking appropriate actions to ensure proper discounts and allowances have been completed as well as identifies account for secondary billing and processes of refers to appropriate personnel.
• Document all activity taken on an account in the patient account notes.
• Work any assigned correspondence related to assigned accounts.
• Performs Verifications of Benefits (VOB).
• Speak to clients/ patients about insurance benefits and financial obligations.
• Perform other required duties in a timely, professional, and accurate manner. Serve as backup for billing specialists as needed. 

Requirements

JOB SKILLS AND ABILITY

• Ability to communicate effectively and professionally with strong attention to details and problem solving both verbally and written.
• Strong telephone communications skills are required.
• Knowledge of carrier-specific reimbursement as applicable to claim processing to include
  • benefits and coverage according to specific carrier
  • UB-04 claims form preparation
  • 1500 claims form preparation
• Ability to prioritize work and meet deadlines is required. Knowledge of general office procedures is required. 
• Ability to operate common computer systems, utilize collection system and business software is required.

EDUCATION AND EXPERIENCE

• Required High School Graduate or GED equivalent.
• 1 year health care collections experience or business office management experience; behavioral health collections experience preferred. 
• Experience with CMD preferred.