Medical Collection Specialist

At SCP Health what you do matters

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.

Why you will love working here:

- 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.

Job Responsibilities:

• 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.

Knowledge Skills and Abilities:

• 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.

Education (Required and/or Preferred):

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

Work Experience/Qualifications:

• 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 (EOBs) 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.
• 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.

Primary Location:

• Dallas TX Office (On Site 4 days a week / 1 day remote)

Pay Range:

This range represents the anticipated base salary for this role. Actual compensation will be determined based on experience qualifications and internal equity considerations.

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We offer a comprehensive benefits package designed to support your health financial well-being and work-life balance including medical dental vision insurance a 401(k) plan with a company match paid time off and holidays professional development support and employee wellness resources.

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