Medical Collections Specialist Resume Samples

Description :

1. Performed collections that resulted in, 25% financial profit for healthcare company.
   
2. Acquired immediate payment, with a 95% success rate.
3. Resolved discrepancies in records regarding durable Oxygen Equipment.
4. Arranged for debt repayment or establish repayment schedules, based on customers' financial situations, also Medicare, Medicaid and HMO follow-ups for patient payments, on respiratory equipment.
5. Performed bookkeeping work, including posting data and keeping other records concerning costs of goods and services and the shipment of goods.
6. Referred unresolved customer grievances to designated departments for further investigation.

Experience

10+ Years

Level

Senior

Education

Criminal Justice

Description :

1. Make contact with insurance company, vendor and patient to learn status of payment.
2. Wrote appeals to insurance companies to overturn denied or short paid claims.
3. Re-billed claims that are lost by insurance company/vendor and provide substantiating documentation if necessary.
4. Obtained necessary documentation (updated medical order, clinical notes, patient agreement, etc.) and submit to insurance carrier to affect payment of claim.
5. Contacted patient, physician office, and territory manager to relay and/or obtain pertinent information and/or documents to effect collection of claims.
6. Make a minimum of 125 calls per day to debtor.
7. Followed-up on claims processing to ensure timely payment, Ensure that all patient information is accurately entered in the proper billing or practice management systems.

Experience

10+ Years

Level

Senior

Education

General Education

Description :

1. Remotely accessed clients billing and medical records systems to complete the AR process making sure to document each account properly.
   
2. Reviewed EOBs, posted payments, and worked EOBs with nonpayment and underpayment issues -Researched nonpayment/underpayment issues and submitted an electronic or paper corrected claim.
3. Called Medicare, Medicaid, Work Comp, VA, and Commercial Insurance companies to resolve nonpayment issues or to verify insurance.
4. Formatted appeal letters, retrieved appropriate medical records and documentation to support claim, and filed appeals with insurance companies to resolve disputes.
5. Sent out patient statements, called patients to discuss past due accounts and took credit card payments or set up payment arrangements.
6. Filled attorney medical record requests by filling out affidavits, attaching medical records, and getting papers notarized.
7. Trained employees to do posting and collection duties, calculated employee time for payroll, posted online employment ads and reviewed resumes for employment to deliver to upper management to review.

Experience

7-10 Years

Level

Management

Education

Medical

Description :

1. Worked with various hospital and health care facilities in the Western United States to secure payments from individual patients as well as insurance companies.
2. Insuranced verification for unbilled services, making customers aware of co-pays / deductibles that have left balances they are responsible for.
3. Reviewed and appeal unpaid and denied claims, Identify and bill secondary or tertiary insurances, Run and build reports as required, and Respond to patient and/or insurance companies billing questions.
4. Coordinated with insurance companies to reconcile denials and provide supportive documentations for proper claims process.
5. Tracked AR and to assure that the aging is up to par.
6. Used Phone calls to payer and resubmit corrected claim and/or appeals letter for claims reprocessing for proper reimbursement.
7. Contacted clients about overdue bills and accounts via telephone.

Experience

7-10 Years

Level

Management

Education

Master Of Education

Description :

1. Performed collection activities on accounts for various Hospitals in and out of state.
2. Communicated with patients, insurance companies, attorneys, employers and physicians to resolve payment difficulties or arrange satisfactory payment plans.
3. Documented detailed collection activities following established procedures into the appropriate Patient Financial System (PFS) such as Quantrax, Intelec and Rumba AS/400 other systems as necessary.
4. Accurately documented all smart codes on each account and conducted thorough research on aged accounts to determine if they need to be escalated to management.
5. Ensured documentation is detailed and that all avenues to resolve the balance have been completed before escalating.
6. Communicated with patients regarding their accounts and solicits their involvement.
7. Performed other duties as assigned or requested.
   

Experience

2-5 Years

Level

Junior

Education

Commercial Pilot

Description :

1. Analyzed and performed follow up activities in a timely manner on all accounts to ensure prompt payments from insurance carriers.
2. Commercial Insuranced, Worker's Compensation, and PIP claims Document accounts correctly and accurately.
3. Initiated collections proceedings on unpaid claims via telephone or insurance's website.
4. Contacted patient's when necessary to resolve payment concerns.
5. Reviewed and resolved all assigned correspondence, denials, EOB's in a timely manner to ensure proper claim reimbursement and avoiding untimely filing.
6. Filed appeals in a timely manner with proper documentation.
7. Prepared claims for secondary insurance billing and mail to carrier with necessary documents.
8. Identified and notified supervisor of any contractual issues, as well as identifying new trends of insurance's improper or inconsistent denials.

Experience

2-5 Years

Level

Junior

Education

Medical

Description :

1. Handled incoming calls and placed outbound calls for collecting delinquent medical accounts.
2. Performed follow up with insurance claims department on unpaid medical accounts.
3. Successfully negotiated account resolution through full payments, settlements, or partial payments.
4. Operated within the guidelines of the Fair Debt Collection Practices Act (FDCPA), Health Insurance Portability and Accountability Act (HIPAA) and any other applicable Federal or state laws and company policies.
5. Awarded highest quality control awards for maintaining exemplary performance on all assigned tasks.
6. Used Excellent verbal and written communication skills Thorough understanding and interpretation of all federal and state laws regarding third party collection practices.
7. Negotiated skills in compliance with the clients requirements.

Experience

10+ Years

Level

Senior

Education

Bachelor Of Science

Description :

1. Reviewed open accounts for collection efforts.
2. Make outbound collection calls in a professional manner while keeping and improving customer relations.
3. Resolved client-billing problems and rescues accounts receivable delinquency, applying good customer service in a timely manner.
4. Collected customer payments in accordance with payment due dates.
5. Identified issues attributing to account delinquency and discuss them with management.
6. Reviewed and monitored assigne accounts and all applicable collection reports.
7. Provided timely follow-up on payment arrangements.
8. Mailed correspondence to customers to encourage payment of delinquent accounts.

Experience

2-5 Years

Level

Junior

Education

Diploma

Description :

1. Worked with all Medicare replacements, Humana PPO and HMO, Most commercial Insurance.
   
2. Followed with claim status, appealed unpaid claims, disputed denail decision for payments.
   
3. Verified eligibility for new updated carriers.
4. Worked on old age claims, based on the denials appealed and got the claims paid.
5. Able to use all resources available and go further and beyound to get the job done.
6. Responsible for reviewing patient accounts for unpaid bills.
7. Generate and follow-up on collection reports for collection attempts.

Experience

2-5 Years

Level

Junior

Education

Medical Assistant

Description :

1. Processed claims through NaviNet for most commercial payers.
2. Processed claims through Promise for PA Medicaid.
3. Worked current A/R from 30, 60, 90, 120, daily Researched all A/R, backdating four years of denial claims.
4. Contacted insurer's on denials, incorrect payments and appeals.
5. Wrote appeals, providing backup support to all Commercial Insurer's and Medicaid.
6. Wrote up Commercial Bad Debt and Medicare Bad Debt.
7. Verified authorization with insurer's by calling.

Experience

5-7 Years

Level

Executive

Education

Medical