Medical Collections Specialist
Medical Collection Specialists is responsible for the support in the general activities of the Medical Collection department. This will include denial management and appeals for designated rejections. The Medical Collection Specialist will be the subject matter expert on their specific segment of the business unit.
In alignment with the core values of Schumacher Clinical Partners the Medical Collection Specialist role aligns with the organization’s core values by:
Agility: The Medical Collection Specialist must possess the ability to skillfully prioritize and manage multiple duties concurrently. The Medical Collection Specialist must be able to assess the needs of the team/organization and swiftly make decision to further advance our business unit.
Respect: The Medical Collection Specialist must foster a team environment always taking the team culture and needs in mind. The Medical Collection Specialist will spearhead the development of a supportive, empowering place of business, which allows maximum success.
Courage: The Medical Collection Specialist must be willing advocate for the organization when outside forces jeopardize team and company objectives.
Collaboration: The Medical Collection Specialist will work with ALL business partners within the company and foster a “One-Team” approach.
- Review Accounts Receivable (AR) by payer on a daily basis to ensure reimbursement goals and days in AR are maintained or achieved.
- Research and resolve invoices routed to the Specialists Views, including Escalated Views, CE View, Correspondence View, Rejection View, etc.
- Prepare required appeals relating to past timely filing, medical necessity, and other various denials, in a timely manner.
- Prepare reports for management including but not limited to denial and rejection trending reports and facility analysis.
- Provide regular feedback to management, based on research and calls to payers, to establish payer behavior trends.
- Provide weekly feedback on payer/facility adjudication concerns.
- Document and ensure each Schumacher Group Special Arrangement is processed correctly and returning the expected results.
- Monitor and maintain a high level of productivity and quality of work.
- Produce a minimum of 55 outcomes per day on Medical Collection Views unless otherwise assigned.
- Achieve a minimum score of 90% on all Quality Assurance audits.
- Communicate regularly with management regarding successes and issues
- Any other duties deemed necessary by management.
Knowledge, Skills, and Abilities:
- Understanding the overall revenue cycle process through final adjudication of accounts.
- Excellent written and oral communication skills.
- Excellent interpersonal skills.
- Detail oriented and organized.
- Ability to work well in a team environment.
- Professional attitude and demeanor.
- Self-starter and problem solver.
- Willingness to cross-train.
- Ability to conduct Department Presentations.
EDUCATION (Required and/or Preferred):
- High school – Required
- Medical Insurance Denials Management – 3+ years of experience