Medical Insurance Collections Specialist

Beraja Medical Institute has been serving the South Florida community for 30 years and we are committed to providing our patients with the latest and most advanced procedures and equipment available to treat all eye diseases

The surgical results and the satisfaction of our thousands of patients have made us one of the leaders in the field of eye care in South Florida.

Medical Insurance Collections Specialist is responsible for the resolution and collection of problematic and aged insurance claims on behalf of clients. The daily functions include contacting insurance carriers for claim status updates, resubmission of claims, prepare and submit appeals when necessary, etc. Additional responsibilities include routine follow-up on rejections and denials, communicating with insurance carriers/third parties.

Essential Functions

• Ability to process rejections and denials to determine if a claim needs to be refilled or submitted and appealed with thecarrier
• Ability to meet minimum daily and monthly productivity and performancemetrics
• Identify claim denialcauses
• Validate all carrier appealrequest
• Ability tohandlecomplex calls;identifyingtheproblem andescalatingissuesasneeded.
• Work accounts based on aging report within the practice managementsystems
• Determines most effective means of collection for each account, applies standard due diligence practice to collect monies owed, composes correspondence requiring knowledge of procedure and practices in collections and also sends a variety of standard collectionletters
• Compiles information and prepares a variety or reports on collection activities for manager, such as outstanding and current accountsstandings
• Maintain proper notation in practice managementsystem

Additional Responsibilities

• Ability to adhere to policy and procedures set company wide andinterdepartmentally
• Strong interpersonal and communication skills with an ability to work effectively with a wide range of people, teams, managers, supervisors, and third partypayers
• Attends department meetings and training seminars to obtain information and department updates.
• Ability to make sound and evaluative judgments; strong organizational problem solving and analyticalskills
• Maintain professional appearance and personal conduct at alltimes
• Work asateammember withinthedepartment
• Document work processes asrequired
• Perform other duties asassigned

Core Competencies

• Knowledge of Billing Guidelines and ICD-10, CPT and HCPCS coding.
• EthicalConduct.
• Leadership.
• PersonalEffectiveness/Credibility.
• Thoroughness.
• Time Management.
• Efficiency.
• Confidentiality.

Required Education and Experience

• Graduation from accredited high school or equivalent.
• Associates degree in related field ofstudy.
• Medical Billing and ProgramDiploma.
• More than 2 years in Medical Billing andCollections experience.
• Experience with Medicare and Medicaid billing guidelines and rules, insurance reimbursement methods, the claims appealprocess.
• Understanding of managed care contracts andcapitation payments.
• Experiencewithbillingandcollectionsofphysiciancommercialinsurances.
• Computer proficiency in Word, Excel, Outlook, along with general knowledge of internet research and medical billingsystems.

Preferred Education and Experience

Certified Professional Biller Certificate (CPB) Preferred

Bilingual English and Spanish

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

BENEFITS PACKAGE:

Health Insurance, Dental Insurance, Vision Insurance and Paid Time Off (PTO), Employee Assistance Program

Relocation Assistance Available*

We are a drug-free workplace

All your information will be kept confidential according to EEO guidelines.

AAP/EEO Statement

We are an Equal opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for their job. Duties, responsibilities, and activities may change at any time with or without notice.