Collections Specialist - Healthcare jobs in Wyoming

MHSC is an equal employment opportunity employer and does not discriminate on the basis of gender, age, race, color, creed, religion, national origin, marital status, sexual orientation, gender identity, mental or physical disability or uniformed services status. MHSC is dedicated to fostering an inclusive environment that recognizes the contributions and supports the advancement of all because an inclusive environment can enhance the quality of healthcare, improve hospital/community relations, and positively affect the health status of society. No candidate will be rejected based on any of the above or any disability that, with reasonable accommodation, does not prevent performance of the essential job duties.

Position Summary

The Lead Collection Specialist is responsible for supervising billing team in ensuring accurate billing, timely submission of electronic and/or paper claims, monitoring claim status, researching rejections and denials, documenting related account activities, posting adjustments and collections of Self-pay, Medicare, Medicaid, Medicaid Managed Care, and commercial insurance payers. The Lead Collection Specialist must possess leadership skills, critical thinking skills and thorough understanding of Medicare, Medicaid eligibility requirements as well as commercial insurance payer payment methods to train new team members and answer any billing related questions the team may have. In addition, the Lead Collection Specialist must demonstrate proficiency with the billing system to ensure all functionality is utilized for the utmost efficient processing of claims.

Major Responsibilities

1. Understand and stay informed of the latest billing guidelines for Medicare, Medicaid, MCOs, commercial insurances, 

    and self-pay.

2. Serves as a team lead and a primary contact of billing operations for payers and MHSC internal departments.

3. Display excellent management skills and a track record of meeting goals and deadlines.

4. Promote effective working relations, work efficiently, and maximize team morale and its ability to meet goals and

     objectives.

5. Assist with management oversight of billing staff to include recommendations for recruitment, placement, approval

   of employees’ time off request, training and development, performance evaluation, compliance, succession  

   planning, terminations, and backfills.

6. Coordinate workload and complete monthly performance productivity and quality review across the billing team.

7. Provide coverage due to absences such as vacancies, vacations, and illnesses, which would include completing the

     responsible billing functions that are uncovered due to absence.

8. Check daily claim electronic submission is completed successfully on designated claims scrubber.  

9. Monitor unpaid claims and ensure they are being followed up in a timely manner.

10. Generate daily, weekly, monthly report including but not limited to unpaid claims.

11. Handle escalated or complex claims issues.

12. Assists billing and collection teams to accurately complete refund requests in a timely manner.

13. Identify denial trends and works with the Denial Team and Director of Patient Financial Service to address the root cause.

14. Manage Discharge Not Final Billed reporting to ensure claims are processed within 4 days from encounter visit/discharge.

15. Provide weekly updates on billing related to Discharge Not Final Billed and/or Denial Management and attend weekly huddle, as requested.

16. Maintain highest confidentiality; adheres to all HIPAA guidelines/ regulations.

17. Perform other duties as assigned to support MHSC’s Mission, Vision, and Values.

Customer Service:

1. Support co-workers and engage in positive interactions.

2. Communicate in a manner consistent with positive patient relations and prompt and accurate reimbursement.

3. Demonstrates friendliness by smiling and making eye contact when greeting all customers.

4. Provides helpful assistance in anticipating and responding to the needs of our customers.

5. Collaborates with customers in planning and decision making to result in optimal solutions.

6. Ability to stay calm under pressure and deal effectively with difficult people.

All duties and requirements must be performed consistent with the MHSC and Performance Standards.

Position Requirements

Education

Minimum: High-school diploma or equivalent.

Preferred:

Associates or bachelor’s degree in healthcare related field to include business administration and at least one healthcare revenue cycle/billing credentials such as:

• Certified Medical Reimbursement Specialist (CMRS)
• Certified Revenue Cycle Specialist (CRCS)
• Certified Revenue Cycle Representative Program (CRCR)
• Certified Revenue Cycle Professional (CRCP)

Work Experience

Minimum

Three years of relevant experience in Patient Financial Services in a healthcare organization to include a hospital, physician practice, or medical group and at least one year in the capacity as a Collection Specialist.

Preferred

Five years of healthcare Revenue Cycle operational experience in a lead or supervisory capacity.

Required Skills, Knowledge, and Abilities

• Understanding of medical terminology and insurance laws/guidelines.
• Collaborate with departments within MHSC and payors to resolve billing inconsistencies and errors.
• Windows application and working knowledge of Microsoft Excel.
• Excellent verbal and written communication skills.
• Self-motivation, initiative, and decision-making skills.
• Effective interpersonal skills which foster a team approach to problem solving and ensure high degree of customer satisfaction.
• Ability to act professionally, independently, and efficiently.
• Demonstration of service excellence and the ability to incorporate the mission and core values into daily activities.
• High energy, flexible, optimistic, attitude with ability to handle multiple demands.
• Knowledge of third-party payer reimbursement
• Experience with the healthcare software system including EMR (clinical and financial) is highly desired.