Medical Collections Representative (In-Office )

Job Description

This is an in-office full time position, please do not apply if your are only seeking a remote of hybrid role

Summary: The Medical Collections Representative is responsible for facilitating the collection of accounts receivable, applying payments to customer’s accounts, negotiating settlements, and maintaining accounts receivable records. The essential responsibilities are typically a variety of projects of significant scope and complexity. Work is subject to periodic review upon completion and is typically performed under general direction.

Essential Duties and Responsibilities:

Answer accounts receivable telephone inquiries and follow up.

Respond to mail correspondence, mail determinations, Explanation of Benefits, or requests for information from payors.

Call and/or mail correspondence to customers, as necessary, in order to update accounts.

Call and/or mail correspondence to payors regarding unpaid charges, including creating and mailing written appeals, rebuttals, and resubmissions to payors regarding unpaid charges.

Collect, verify, and record key information on accounts for billing and/or litigation purposes.

Maintain reporting on customer/patient accounts receipts/payment received from patients or payors.

Obtain and mail invoice copies for customers, as requested.

Prepare and review Patient Statements and submits for payment.

Research and process customer claims of invoice payment.

Research and process charge backs, returns, and bad checks.

Research customer credit, skip traces, locates assets, and ability to pay.

Regularly check on status of unresolved liens with attorney or payors.

Assist with other assignments or special projects, as required.

Review existing solutions to determine best methods for solving problems.

Assist with development of proactive problem solving methods as they relate to Insurance operations &/or Company processes

Make routine decisions requiring moderate use of independent judgment.

Troubleshoot and resolve problems through all departmental processes.

Assist with training/guidance of other non-exempt staff and team members

Identify concerns &/or recommendations for process improvement.

Analyze account information and determines appropriateness of continuing service on account.

Analyze payment record on accounts and determine timing of appeals, filing of liens and/or Declaration of Readiness to Proceed documents.

Competency:

Job Specific Duties: To appropriately and effectively support the function and activities of the Insurance Department

Decision-Making, Judgment, Problem Solving: To act on familiarity of advanced concepts, principles, procedures that apply to job assignments to achieve solutions.

Job Knowledge: To act on Familiarity of most relevant company policies and advanced concepts that apply to departmental policies, procedures & specific job tasks to complete a wide variety of routine & unique projects.

Project Management, Planning & Organization: To effectively plan and organize responsibilities to complete assignments within required parameters and pre-established time-management standards.

Communication & Ethics: To appropriately and ethically represent the company and initiate actions and/or communications which will best serve the interests of VQ OrthoCare

Qualifications:

• 2+years of commercial medical collections (HMO, PPO, Medicare is a plus). Back end collections not Front end experience

• Familiar with the overall denial and appeals process

• Must have knowledge understanding of Explanation of Benefits (EOB), ICD-10 and HCPC codes

Education and Experience:

• High School Diploma/GED

• 2+ years related experience or equivalent of education plus directly related education, training and experience

• Preferred experience includes collections experience in a medical device workplace environment.

Physical and Mental Demands:

Typically interacts with staff, peers, senior management and external customers

Ability to handle moderate to high stress

Regularly required to sit, stand, move about, stoop, bend, reach, finger and grasp and to move and/or lift up to 50 pounds

Regularly must see and read computer displays and reports, PDA displays & cell phone displays

Must regularly type and or enter data using computer keyboards.

Certificates and Licenses:

No special certificates, licenses or registrations are required

Supervisory Responsibilities:

The job has no supervisory responsibilities.

Work Environment:

Reasonable accommodations may be provided in order to allow qualified individuals with disabilities to perform the essential duties and tasks.

The work environment varies between that of a typical office setting with controlled temperature and humidity and a typical automobile interior, traffic and noise associated with commuting, along with typical patient home environments for short durations. Ambient noise levels are consistent and generally low to moderate.

**VQ OrthoCare is and Equal Opportunity Employer: All Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

***VQ OrthoCare is a participating E-Verify employerCompany Description

VQ Orthocare is a DME manufacturer and retailer recently celebrating our 25th year!