Job Description

Purpose: The Reimbursement Specialist – Collector is responsible for ensuring the timely and accurate follow-up on all claims, maintaining effective communication with payors, patients, and caregivers as necessary. This role also involves cross-training with team members to provide support in additional billing and payment posting functions as required. 

Essential Duties & Responsibilities: 

Manage the collection of outstanding balances from both insurance companies and patients 

Conduct timely follow-up on all submitted claims to ensure prompt resolution 

Review and correct rejected claims as necessary, ensuring accurate and timely resubmission to maximize reimbursement 

Identify, document, and address claims/billing errors, denials, and rejections 

Analyze claim denials and rejections to identify root causes and implement strategies to prevent future occurrences 

Collaborate with internal departments to address systemic issues leading to denials 

Appeal denied and short-paid claims to maximize reimbursement  

Establish and manage patient payment plans as necessary 

Initiate contact with customers and insurance companies via phone or mail to facilitate payments and resolve account issues 

Monitor and manage Accounts Receivable  

Assist in the preparation of documentation for audits and ensure adherence to regulatory requirements 

Maintain up-to-date knowledge of insurance policies, billing regulations, and compliance standards 

Uphold confidentiality and adhere to HIPAA standards for handling Protected Health Information (PHI) 

Perform additional duties as assigned to support the overall function of the reimbursement department