Accounts Receivable-Collector

United Surgical Partners International - San Antonio, TX

Full-time

San Antonio, TX

Ambulatory Health Care Services

About the position

The Accounts Receivable Collector is responsible for managing and resolving outstanding accounts receivable, including unpaid, underpaid, and denied claims across various payers. This role involves prioritizing high dollar claim balances, reviewing insurance and patient correspondence, and ensuring maximum reimbursement through effective follow-up and negotiation.

Responsibilities

• Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers.
• Manage daily work queue to prioritize high dollar claim balances.
• Review and work on insurance and patient correspondence including refund requests.
• Send appeals when appropriate or provide the requested medical documentation.
• Review medical documentation to justify medical necessity.
• Handle patient phone calls to resolve inquiries, billing issues, or outstanding balances.
• Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules, or summary plan documents.
• Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD's) for claim resolution.
• Negotiate payment amounts for procedures with Third Party Administrators for out of network providers.
• Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients.

Requirements

• 2+ years of revenue cycle experience.
• Ability to read and interpret insurance explanations of benefits and managed care contracts.
• Effective communication skills, both verbally and in writing, with internal and external clients.
• Ability to multi-task and handle competing priorities while meeting or exceeding deadlines.
• General knowledge of the healthcare industry insurance/EOB payment process.

Nice-to-haves

• Knowledge or experience working with a variety of health care insurance payers.