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 the carrier
• Ability to meet minimum daily and monthly productivity and performance metrics
• Identify claim denial causes
• Validate all carrier appeal request
• Ability to handle complex calls; identifying the problem and escalating issues as needed.
• Work accounts based on aging report within the practice management systems
• 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 collection letters
• Compiles information and prepares a variety or reports on collection activities for manager, such as
  outstanding and current accounts standings
• Maintain proper notation in practice management system

Additional Responsibilities

• Ability to adhere to policy and procedures set company wide and interdepartmentally
• Strong interpersonal and communication skills with an ability to work effectively with a wide range
  of people, teams, managers, supervisors, and third party payers
• Attends department meetings and training seminars to obtain information and department updates.
• Ability to make sound and evaluative judgments; strong organizational problem solving and
  analytical skills
• Maintain professional appearance and personal conduct at all times
• Work as a team member within the department
• Document work processes as required
• Perform other duties as assigned

Core Competencies

• Knowledge of Billing Guidelines and ICD-10, CPT and HCPCS coding.
• Ethical Conduct.
• Leadership.
• Personal Effectiveness/Credibility.
• Thoroughness.
• Time Management.
• Efficiency.
• Confidentiality.

Required Education and Experience

• Graduation from accredited high school or equivalent.
• Associates degree in related field of study.
• Medical Billing and Program Diploma.
• More than 2 years in Medical Billing and Collections experience.
• Experience with Medicare and Medicaid billing guidelines and rules, insurance reimbursement
  methods, the claims appeal process.
• Understanding of managed care contracts and capitation payments.
• Experience with billing and collections of physician commercial insurances.
• Computer proficiency in Word, Excel, Outlook, along with general knowledge of internet research and
  medical billing systems.

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.