Lead PFS Insurance Specialist

Compensation:

$32.00-33.00 per hour





The Lead Collector’s main role is to lead the collections team towards department goals of increasing cash collections and improving upon reimbursement rates. The Lead Collector should have the ability to work any claim, regardless of aging, and must work with both commercial and government payers, review EOB’s and medical policy to evaluate and submit for appeals, as well as perform in-depth research to appropriately obtain coverage for any denied claims. The Lead Collector will also develop and deliver reports to management to summarize payer and claims issues, and contribute suggestions for policy and process improvements; additionally, the Lead Collector will take point on implementing process changes within their team.

Duties and Responsibilities

• Works with collections team to ensure daily productivity and quality standards are met, as well as assist with training and coaching to ensure all team members are operating at full potential
• Creates notes on the patients account for auditing and actions taken per the Standard Operating Procedures or as outlined by the team manager
• Works the total patient accounts outstanding A/R including credits and denials to reduce A/R aging buckets per the department’s goals
• Researches and understands different payer policies and reimbursement history to improve ability to successfully overturn claim denials through the claims process
• Understands the various Ambry products and tests and can present reasonable arguments for medical necessity on behalf of the patient in order to obtain coverage from the insurance payer
• Works hand in hand with the other team members to correct errors, communicate with team members about payer policy updates and improve work flow processes (e.g. billing integrity)
• Send corrected claims and appeals based on payer guidelines in a timely manner
• Manages write-offs or adjustments on accounts when applicable, as well as process refund requests received from payers to determine if payment errors were made
• Develops and delivers detailed reports to management regarding overall payer issue to support denial management and works to resolve issues at both the claim and payer levels
• Other projects as assigned .

Education and Knowledge:

• High school diploma plus some college preferred
• Knowledge of CPT codes, medical terminology, insurance plans, ICD 10 codes
• Must have experience with Practice Management systems, Telcor experience preferred