Collection Specialist at QSM Health Systems, Inc in Hollywood, Florida

Job Description:

Responsibilities:

Post all payments Medicare FL/NC and Commercial EOB's, drop statements when needed while posting, ensure claims have been tagged/BB'd & printed, fix "claim processing errors detail report"
Present Projects:

Review & note all M/care's denials before giving to appropriate dept
ALL denials from Humana
ALL Humana "Custodial" denials
ALL HMO denials
ALL Medicare's PR-9; 18, CO140

Audit accounts that have open claims - investigate, fix and tag
Do all w/offs on accounts authorized by the Office Manager
Verify that insurance contracts are up to date & paying at correct fee schedule
Monthly statements, including sending all letters and accounts to IC System (Collection Agency)
Verify Insurance coverage for providers when out in the field (before office opens)
Review HCFA's prior to mailing, ensure that charges are entered correctly, attach correct referrals CC pts & Home pts.
Billing:

If Original claim comes back denied create claim to correct insurance (e.g.; pt becomes hospice or is enrolled with a different insurance company, etc).
Review all Medicare EOB's for secondary payments
Enter Secondary Insurance information from Medicare EOB & 2ndary payment

Do all mail pertaining to patients, review all denials fix and resubmit corrected claims commercial & medicare PR B9's, help in the expedition of certain issues, update address and/or make adjustments to return statements.
Past Projects:

Vista & Humana - Resubmit all claims that were unpaid but collected 99%
Claims - Over 300 claims never printed sent & 98% got paid
Resubmit any/all Medicare denials listed on the EOB
Document all reconsiderations, ADRs in pt's accounts.
Review all denials.

Assist Front Office, ensure patients haves the correct balance on account
Translate Practice forms from English to Spanish.
Become familiar with and abide by all company policies and procedures as set forth by management