United Surgical Partners International, Inc
Hospital A/R Collector
United Surgical Partners International, Inc, Dallas, Texas, United States, 75215
Position Overview
Reporting to the Hospital Collections Supervisor, the Collector must have a strong knowledge of medical collections, accounts receivable, insurance billing and verification, denial processing, appeal submission, and EOB review. This position is responsible for resolving outstanding surgical claims to achieve maximum reimbursement.
Responsibilities
Timely follow‑up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers, including self‑pay, to obtain maximum reimbursement.
Manage daily work queue to prioritize high‑dollar claim balances.
Perform insurance claim follow‑ups for denials and appeals; contact insurance companies to check eligibility and benefits via phone or online portals.
Review payer contracts to ensure claims have been processed correctly.
Maintain knowledge of all payers: MCR, MCR ADVG, Medicaid, Medicare Advantage, and commercial payers.
Review and work incoming insurance and patient correspondence including refund requests.
Prepare and write medical‑necessity appeals when appropriate or provide the requested medical documentation.
Assess medical documentation to justify medical necessity.
Review patient balances to ensure accuracy and follow up with patients to obtain payments.
Verify insurance payments and determine the accuracy of reimbursement based on contracts, fee schedules, or summary plan documents.
Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCDs) for claim resolution.
Negotiate payment amounts for procedures with third‑party administrators for out‑of‑network providers.
Recommend adjustments or refunds for overpayments to insurance carriers or patients, providing appropriate documentation.
Qualifications
3+ years of hospital collections experience preferred.
Excellent communication and interpersonal skills.
Strong time‑management and prioritization abilities for emergent situations.
Professional customer‑service orientation.
Ability to read and interpret insurance explanations of benefits and managed‑care contracts.
Experience working with a variety of health‑care insurance payers preferred.
Intermediate computer proficiency in Microsoft Office, including Excel and Outlook.
Experience with DDE, Ability Ease, nThrive, Cerner, Advantx, Vision, HST, or Waystar preferred.
High school diploma or equivalent.
Job Details
Seniority level: Mid‑Senior
Employment type: Full‑time
Job function: Accounting, Auditing and Finance
Industry: Hospitals and Health Care
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Responsibilities
Timely follow‑up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers, including self‑pay, to obtain maximum reimbursement.
Manage daily work queue to prioritize high‑dollar claim balances.
Perform insurance claim follow‑ups for denials and appeals; contact insurance companies to check eligibility and benefits via phone or online portals.
Review payer contracts to ensure claims have been processed correctly.
Maintain knowledge of all payers: MCR, MCR ADVG, Medicaid, Medicare Advantage, and commercial payers.
Review and work incoming insurance and patient correspondence including refund requests.
Prepare and write medical‑necessity appeals when appropriate or provide the requested medical documentation.
Assess medical documentation to justify medical necessity.
Review patient balances to ensure accuracy and follow up with patients to obtain payments.
Verify insurance payments and determine the accuracy of reimbursement based on contracts, fee schedules, or summary plan documents.
Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCDs) for claim resolution.
Negotiate payment amounts for procedures with third‑party administrators for out‑of‑network providers.
Recommend adjustments or refunds for overpayments to insurance carriers or patients, providing appropriate documentation.
Qualifications
3+ years of hospital collections experience preferred.
Excellent communication and interpersonal skills.
Strong time‑management and prioritization abilities for emergent situations.
Professional customer‑service orientation.
Ability to read and interpret insurance explanations of benefits and managed‑care contracts.
Experience working with a variety of health‑care insurance payers preferred.
Intermediate computer proficiency in Microsoft Office, including Excel and Outlook.
Experience with DDE, Ability Ease, nThrive, Cerner, Advantx, Vision, HST, or Waystar preferred.
High school diploma or equivalent.
Job Details
Seniority level: Mid‑Senior
Employment type: Full‑time
Job function: Accounting, Auditing and Finance
Industry: Hospitals and Health Care
#J-18808-Ljbffr