Medical Collections Specialist

As part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care.

• Strong track record of providing excellent work/life balance.

• Comprehensive benefits package and competitive compensation.

• Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect.

• Review (AR (Accounts Receivable)) by payer daily to maintain or achieve reimbursement goals and days in AR.

• Prepare timely appeals to overturn medical necessity, and various denials.

• Provide regular feedback to management based on payer research and behavior trends.

• Weekly feedback on payer/facility adjudication concerns.

• Improve reimbursement outcomes and resolve outstanding claims inventory.

• Identify the root cause of the non-payment and resolve the claim denial issue, including coding and billing errors, documentation issues and compliance discrepancies.

• Maintain high productivity and quality of work.

• Achieve a minimum score of 95% on all Quality Assurance audits.

• Develop and execute effective appeals strategies to overturn denied claims.

• Prepare and submit detailed and well-documented appeals to insurance companies within specified deadlines.

• Possess knowledge of medical coding specific to professional emergency room and hospital medicine services.

• Collaborate with coding specialists to address and rectify coding-related denial issues.

• Stay current on insurance policies, guidelines, and industry changes affecting emergency room and hospital medicine services.

• Collaborate with the medical billing team to address root causes of denials and implement preventive measures. Provide training to billing staff on denial prevention and resolution.

• Meet production standards.

• Understanding of the overall revenue cycle process through final account adjudication.
• Excellent written and oral communication skills.
• Strong interpersonal skills.
• Meticulous and organized.
• Ability to work effectively in a team environment.
• Professional attitude and demeanor.
• Initiative-taking and problem-solving skills.

• High School or Equivalent
  
  Required:
  
  Proven experience in denial management, specifically in professional emergency room and hospital medicine service.

• 2+ years of experience in Medical Insurance Denials Management.
• 2+ years of experience in customer service and patient billing within the medical industry.
• Experience reading Explanation of Benefits (EOB’s) for Government, Commercial, PPO, HMO/IPA, and Workers’ Compensation payers.
• Ability to review and validate credits to be refunded and validate recoupment demands.
• Intermediate ability to assess and verify patient liability, coinsurance, deductibles, and denial codes.
• I have an intermediate knowledge of MS Office.
• Knowledge of ICD-9, ICD-10, CPT, HCPCS coding, and general claims processing practices.
• 10-key by touch, Proficient in MS Excel, and Word.
• Previous patient medical billing, OnBase, Centricity, and Way Star, Payor Portals experience a plus.

None required.

• Professional setting.
• Continuous sitting.
• Continuous computer use.
• Occasional bending, kneeling, lifting, pulling, and pushing up to ten…