Medical Collections Representative

Pay Range: $24.72hr - $29.72hr

Job Overview:

The Value Based Care Collections Representative I is responsible for resolving assigned account receivables (A/R) of the organization, including account reconciliation, management, and research. The successful candidate will handle unresolved claims inquiries and follow collection policies and procedures to maintain acceptable AR days and payments.

Candidate Profile:

• The candidate will be part of a team that demonstrates superb technical competency.
• The VBC Collections Representative I is responsible for resolving assigned account receivables (A/R) of the organization.
• The candidate will handle account reconciliation, management, and research.
• The representative handles all unresolved claims inquiries and issues while following company collection policies and procedures.
• The candidate may work with outside agencies, vendors, and clients to maintain acceptable AR days, AR aging, and payments.

Roles & Responsibilities:

• Complete Value Based Reimbursement processes timely and accurately according to industry best practices and standards.
• Analyze and properly resolve assigned claims in a timely manner.
• Communicate with carriers, physicians' offices, patients, and management to achieve resolution of issues and claims status.
• Accurately verify insurance benefits related to claims.
• Ensure insurance benefits are updated.
• Process required adjustments according to department protocol.
• Ensure payments are posted accurately.
• Properly appeal claims as needed.
• Obtain medical records and other documents from appropriate resources as needed for claims payment.
• Perform other tasks as assigned by management.

Required Experience / Qualifications:

• High school diploma or equivalent required; Associate or Bachelor's degree is a plus.
• Minimum of 2 years of experience in medical collections; Cardiology experience is a plus.
• Demonstrated proficiency with Microsoft Word, Outlook, and Excel.
• Ability to analyze both patient accounts and payer Explanation of Benefit responses.
• Working knowledge of managed care, contract terms, and medical terminology.
• Strong verbal and written communication skills.
• Excellent organizational skills and the ability to multitask.
• Ability to work well under pressure, prioritize tasks, and meet deadlines.
• Possess a positive attitude and a willingness to learn.
• Ability to work with both internal and external customers in a team atmosphere.
• Self-motivated.