Claims Recovery Collector I

Additional Information:

**Medicaid claims experience, Bilingual and outbound calling experience**

Required Function 1:

We are seeking a talented individual for a Claims Recovery Collector I who is responsible for recovering payments from commercial insurance carriers who should have paid primary to the Medicaid agency

Required Function 2:

Essential Responsibilities:

Confer with Physicians/Providers by telephone, fax, and email inquiries regarding outstanding overpayment recovery

Communicate with claims adjudicators for commercial carriers by telephone, fax, and email to determine claim status and create claim-level appeals

Leverage RCM Knowledge to assess denials, pursue appeals or close claims when appropriate.

Utilize and update client systems with proper notation of provider/carrier commentary, actions, and appeal/denial information.

Responsible for initiating inquiries to other parties as needed to address claim adjudication issues or resolving inquiries associated with claims adjudication

Mail/fax/email letters to Physicians/Providers regarding payment of outstanding claims.

Contact providers to obtain additional information and/or documentation to resolve unpaid claims.

Pursue each outstanding account to reach maximum reimursement by working with subject matter experts to resolve challenging claims.

Required Function 3:

Develop recovery strategies with each claim adjudicator, and/ or physicians/providers associated with the claim billing.

Assists with high priority special projects.

Confer with carriers by telephone or use carrier portals, or other web sites to determine member eligibility and claim status.

Assess denials, pursue appeals, or close claims when appropriate.

Update case management system with proper noting of actions and appeal/denial information.

Respond to carrier telephone, fax, and e-mail inquiries regarding outstanding claims.

Work with document imaging system for archival purposes.

Ensure that payers adhere to laws regarding timely filing of claims.

May have some training responsibilities limited to projects and specific tasks

Required Function 4:

Knowledge, Skills, and Abilities:

Strong understanding of third-party billing and/or claims processing. Ability to use critical thinking skills.

Possess good customer service skills.

Ability to adapt to change.

Ability to manage time effectively and multi-task.

Ability to prioritize work.

Ability to perform basic calculations.

Ability to work proficiently with Microsoft Windows, Word and have basic knowledge of Excel.

Average manual dexterity in use of a PC, phone, sorting, filing and other office machines. Ability to be detail oriented.

Ability to learn and follow HIPAA privacy and Security rules.

Ability to work independently to meet predefined production and quality standards.

Ability to perform well in a team environment to achieve business goals.

Required Function 5:

Work Conditions and Physical Demands:

Primarily sedentary work in a general office environment

Familiarity with basic computer usage and applications

Ability to communicate and exchange information

Ability to comprehend and interpret documents and data

Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.)

Requires manual dexterity to use computer, telephone, and peripherals

May be required to work extended hours for special business needs

Required Function 6:

Minimum Education: -

High School Diploma or GED required, Associates degree preferred- Associates degree preferred with concentration in healthcare, medical billing, or coding field

Required Function 7:

Minimum Related Work Experience: -

Two years of claims-related experience or provider billing/coding experience, which included significant use and application of CPT/ICD codes and standard health industry claim billing forms. Must be able to demonstrate knowledge of medical terminology, coding, billing, and claims processing obtained through work experience and/or completion of relevant claims, coding, or billing coursework.>Preferred experience handling and interpreting medical records, EOBs, and standard health industry claim billing forms