POSITION: Denials/Collections Specialist

LOCATION: Remote, but must live in MASSACHUSETTS

HOURS: FT/M-F

Shields Health Care Group is hiring Denials/Collections Specialist for our Ambulatory Surgical Centers. Shields has over 30 years of healthcare experience and has successfully organized, developed and managed a broad array of healthcare services. Our joint venture surgical centers are a collaboration to design, build and operate an outpatient surgery center dedicated to the provision of high-quality care in a lower cost, convenient setting meeting patient demand for routine surgery to be performed in a less complex setting

JOB RESPONSIBILITIES:

• This position involves collecting and managing accounts, following up with insurance companies, reconciling accounts, filing corrected claims, appealing claims when appropriate, and following up on all denials to ensure reprocessing and payment in a timely manner.
• Candidates should have knowledge of calling payers, commercial, Medicare and Medicaid for claims follow up.
• The A/R Specialist will take pride in their results and aggressively pursue every avenue of payment available to maximize reimbursement of each account within his/her area of responsibility for OakBend Medical Center. Being the advocate to collect and manage each account appropriately on behalf of the patient is the path to success for this role's key part in the organization.
• Detailed responsibilities will include direct contact with payer representatives, prioritization of claims to optimize money collected, meeting team productivity goals, verifying the accuracy of payments received and timely follow up on discrepancies and denials.
• Proficiency across a wide range of revenue cycle services, including coding, multispecialty operative reports, billing, payment posting, appeals, denial management, patient collections and third party reimbursement mechanisms.
• Adjustment functions, adjudicating, identifying, analyzing, reducing and resolving revenue enhancement
• Assist in development of AMKAI, SimplePay, Clariti and Zirmed software systems processes and procedures
• Coordinate with scheduling, nursing, external physicians central sterile on workflow and process to maximize efficiency
• Report to ASC Revenue Cycle Manager metrics, to include collections, denials and DSO.

QUALIFICATIONS:

• Minimum 3 years of ASC revenue cycle experience
• Superior customer service skills that uphold the Shield’s values at all times
• Professional and effective verbal communication skills that instill confidence in our community
• Understand patient’s liability as it pertains to deductibles, coinsurance, copays and/or lack of insurance coverage.
• Must have working knowledge of CPT and ICD codes.
• Ability to follow verbal and written instructions.
• Ability to prioritize and complete tasks in a timely manner.
• Ability to be cross-trained in other areas.
• Experience using a medical software billing system.

EDUCATION:

• Minimum 3 years of revenue cycle experience or Bachelor’s Degree and 2 years of revenue cycle experience

INTERNAL/EXTERNAL INTERACTIONS:

Extensive interactions with all customer groups, including patients, families, referring community and SHC employees.

NOTE: It is not intended that this Job Description include all details of the work functions of this position. The incumbent will perform work of a lower or equivalent classification as required or directed, and work of higher classification for training and development purposes or as situationally warranted