Medical Collections Specialist; BCBS

It’s the people that make the difference. Are you ready to make your impact?

Midwest Orthopaedics at Rush, with locations in Chicago and the Western Suburbs, is nationally recognized as a leader in comprehensive orthopedic services. The physicians of Midwest Orthopaedics at Rush have received specialized training in orthopedic surgery and in subspecialty areas within the field of orthopedic medicine and can diagnose and treat even the most complicated and rare musculoskeletal conditions. The Orthopedic Program at Rush University Medical Center is ranked Top 10 in the nation by U.S. News and World Report.

Midwest Orthopaedics at Rush doctors are the official team physicians for the Chicago White Sox, Chicago Bulls, Chicago Fire Soccer Club and DePaul University Athletics.

Ready to join? We are seeking a full-time Collections Specialist to join our team. In this role you will be responsible for processing insurance claims, managing patient accounts, resolving unpaid or rejected claims for orthopedics patients, resolving overpaid claims,capturing and investigating denial trends and collaborating with the team lead and/or management to help resolve the challenging claims . You will maintain accurate claim and account information, respond to account inquiries from both the patient and the practice,and document all patient interactions.

We are looking for a candidate with expertise in BCBS payor. This position offers the opportunity to work remotely. Candidate must be flexible to travel to the corporate office in Westchester, IL for training and as needed for team meetings.

include the following. Other duties may be assigned.

• Analyzes authorizations, claims, explanation of benefits, correspondence, payor website and/or any additional information necessary to identify the next appropriate action toward payment resolution.

Follows commercial payor guidelines to ensure complete and timely follow-up on open balances for assigned payors or accounts in a timely manner.

Performs appeals, underpayment appeals, and disputes by following commercial, payor appeals guidelines or contracted terms. Utilizes payor contracts and fee schedules to perform underpayment appeals or collaborates with the practice to obtain medical necessity appeals documentation. Assists with tracking appeals outcomes.

• Contacts patients or appropriate payor representatives via phone or electronically to resolve claims and/or coordinate benefits and submits claim in the correct filing order. Works to identify other payors when possible and ensures all payors and filing order is correct in the practice management system.

Collaborates with the team lead to identify patterns and interpret denial trends. Notifies Manager when insurance plans deny services, which are covered based on the contract terms, government regulations, third party agreement or patient’s benefit plan.

• Works to minimize write-offs by exhausting all resolution options and performing thorough research/review of all appropriate resources. Adjusts account or requests write- offs adhering to MOR policies and procedures.
• Reviews denial reports and makes recommendations for billing or claim submission changes based on claim denials.
• Research payor and government websites and/or medical resources, to identify payor claim requirements required to resolve open accounts receivable.
• Collaborates with Coding Team or physician to resolve coding related denials and submits all coding related corrected claims and/or appeals.
• Targets and reports any internal procedures or processes that may negatively impact or increase days in accounts receivable or delay claims resolution.

Interact with patients and commercial payors to respond to billing requests…