IntePros is seeking a Collections Representative to join our Philadelphia-based healthcare client. This person is responsible for ensuring accurate and timely reimbursement from third-party payors for services provided by our client. This role involves performing insurance follow-up, denial management, and accounts receivable (A/R) collection processes to maximize revenue recovery. The representative will work on resolving denials, rejections, and credit balances while ensuring compliance with contracts and policies.
Key Responsibilities:
Insurance Follow-Up & Denial Management
- Investigate and resolve accounts flagged for low payment, denials, or other reimbursement issues.
- Perform follow-up actions by contacting insurance companies via phone, email, fax, or written correspondence.
- Document actions taken, ensuring thorough and complete notes in the system.
- Analyze denial trends and barriers to timely claims processing, including issues related to network setup, fee schedules, and provider enrollment.
- Ensure claims, appeals, and any required documentation are submitted within designated timeframes.
- Process and reconcile Explanation of Benefits (EOBs), identifying necessary actions for resolution.
- Submit claims with correct and appropriate attachments based on policies and payor requirements.
- Participate in special projects, audits, and reconciliations as needed.
Credit Balance Reconciliation
- Review and reconcile credit balances to determine appropriate action.
- Submit refund requests following internal policies or coordinate with payors for off-sets or retractions of overpayments.
Adjustments & Write-Offs
- Investigate and submit for approval any necessary write-off allowances or adjustments in accordance with client contracts and policies.
Additional Responsibilities:
- Collaborate professionally with co-workers and client staff in areas such as registration, physician billing, and patient access.
- Meet production and performance targets as set by the department.
- Work correspondence daily and complete other duties as assigned.
Qualifications:
Education & Experience:
- High school diploma or equivalent required.
- Experience in insurance follow-up, A/R collection, and denial management for commercial and government payors.
- Experience in physician billing and/or anesthesia billing is preferred.
- Epic experience is required.
Skills & Competencies:
- Strong knowledge of insurance follow-up, denials, reimbursement processes, contracts, and insurance policies.
- Proficiency in Microsoft Excel, including working with large data sets.
- Strong analytical and problem-solving skills.
- Ability to manage multiple tasks, meet deadlines, and maintain confidentiality.
- Excellent verbal and written communication skills, including professional phone etiquette.
- Strong customer service skills and ability to work collaboratively with internal and external stakeholders.