Provides collection services to the TLRA Insurance Unit. Utilizes a strong background as a medical collection specialist to successfully resolve accounts placed with the insurance department for collection. Possesses a vast knowledge of all types of medical provider accounts and utilizes this knowledge to ensure maximum reimbursement for TLRA clients. Utilizes communication skills to collect and settle accounts as well as communicating with patients, clients, reimbursement vendors, and other external entities. Client satisfaction is essential in the collection specialist position. This position also handles a collection queue of accounts. Works under the supervision of the Insurance Collection Supervisor and Operations Manager.
Performs medical collection functions relevant to the TLRA Insurance Department in a manner that meets or exceeds CHRISTUS Health key performance criteria as it relates to cash collections, aged accounts receivables and denials.
Contact will be made with payers through written correspondence, online inquiries or phone to obtain claim status, clarification or to escalate resolution of patient accounts. Exhibits excellent verbal and written communication skills.
Responsible for researching and resolving accounts. Review proper account handling and applies corrective actions as necessary.
Understanding of insurance denials and underpayments and routes account to proper department for assistance in resolution. Exhibits excellent problem solving skills.
Reviews account payment for accuracy utilizing an insurance explanation of benefits, online resources or contracts. Determines if balance should be moved to the next responsible party.
Ensures proper reimbursement for all services. All appeals are filed timely in accordance with payer regulations or contracts. Understands state insurance laws and the various appeals processes.
Ensures quality and productivity standards are met. Appropriately documents patient accounting host system or other systems utilized by TLRA in accordance with policy and procedures.
Provides continuous updates and information to TLRA Insurance Leadership Team regarding ongoing errors, payer related issues/trends, registration and other controllable QA related activities affecting productivity, reimbursement and/or payment delays.
Maintains thorough and detailed knowledge of state and federal collection laws, third-party payer claims processing and appeal procedures as well as the different payment methodologies. Ensures compliance with state and federal laws regarding all cash collections activities.
Functions effectively within a team and participates and contributes constructively to produce results in a cooperative effort.
Demonstrates ongoing enthusiasm and commitment to the work assigned.
Works with Leadership to receive feedback on performance and create a personal development plan.
Performs other special projects as required and assigned.
High School diploma with a minimum of two years specialized training or certification; College degree preferred
Minimum of five years experience performing collection activities, preferably in a healthcare or patient environment
Advanced knowledge and understanding of healthcare collections and reimbursement practices required
Must be able to work in a team environment, prioritize and organize multiple tasks, and meet deadlines
Strong written communication skills required
Excellent interpersonal skills to effectively interface with internal and external clients and customers at all levels
PC Skills in a Windows environment are required
Solid knowledge and utilization of desktop applications to include Word and Excel is essential
Professional appearance, excellent verbal communication, and time management skills required
Ability to initiate and follow through on projects and work independently with minimal supervision
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.