Remote Insurance/collections Specialist - Los Angeles, United States - Conduent Payment Integrity Solution Inc.

Description

Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them.

You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.

The Insurance/Collections Specialist is responsible for analyzing medical claims data, seeking reimbursement, and recovering overpayments from healthcare providers, third parties, and/or insurance carriers on overpaid medical claims.

These claim overpayments are a result of incorrectly paid claims arising from COB issues, data mining, duplicate claim payments, client referrals, etc.

Including but not limited to analyzing the overpayment data, and handling disputes and appeals from providers, and navigating difficult collection situations to resolution.

Must be able to manage a high volume of incoming and outgoing calls while providing excellent customer service and problem-solving skills.

Will need to be able to maintain positive vendor relations as regular telephone contact with providers (doctor's offices, hospitals, etc.) will be required to initiate the overpayment process.

Need to have strong time management and organizational skills as follow ups with providers must be made to discuss status of overpayment and refund process to ensure account resolution.

The Insurance/Collections Specialist is responsible to meet all performance standards: collection goals, compliance, and production to ensure calls are timely, maximum call time is achieved, and ensures quality results.

• Communicates effectively with other staff/team members.
• Coordinate's collection efforts between the client and the provider, adjusting claims/reversals as required.
• Develops effective collection/recovery approaches and workflows to maximize collection/recovery opportunities.

• Must be experienced medical collections and be able to successfully recover overpaid claims.
• Possess strong analytical skills, medical billing or claims processing knowledge and collections background.
• Basic knowledge of insurance procedures, working with insurance carriers, Medicare, and Medicaid.
• Required to have claims processing knowledge so they can speak to providers in medical billing terms to have claims billed correctly to other payors, explain contractual overpayments, general claim overpayments, duplicates, PPO contract overpayments related to medical claims, Part A and B bundled claims, and workers compensation claims.
• Required to have an understanding and working knowledge of how Commercial claims are processed, including benefits, and coverage.
• Understanding of medical claim denials to know when claims will not be paid by other payors or when providers should appeal or rebill claims with corrections.
• Required to have an understanding and working knowledge of Medicare Part A, B, C and D, including benefits and coverage.
• Be able to understand and interpret Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA) for understanding of allowable rates, rejection codes, patient, and secondary insurance responsibility, and to determine correct overpayment amount.
• General understanding of:
• Medicare Part A, Part B and Part D
• Health Insurance, and Medical.
• Healthcare reimbursement in different settings (i.e., Inpatient, Outpatient, home health, long term care, home infusion, health systems, community pharmacy, and ambulatory clinics.
• Coordination of Benefits (COB) to determine each party's responsibility.
• Interpreting EOB's, ERA's (electronic remittance advice) for understanding of allowable rates and patient accumulations.
• CPT codes, ICD 9/10 codes
• CMS guidelines surrounding Medicare Part A, B and D.
• Must be experienced in medical collections and be able to successfully recover overpaid claims.
• Professional verbal and written communication skills required. Excel knowledge strongly preferred.
• Must possess the ability to work independently and have excellent customer service and communication skills, patience, flexibility, and the assertiveness to achieve goals.
• Strong phone skills and computer skills including MS Office (Word, Excel and Outlook) required.
• Employee must have the ability to speak, hear and see clearly, and will be on the telephone the duration of the daily shift.
• Must be able to sit for long periods of time.

• Minimum 1year experience with medical billing/insurance collections.
• Training certificate or only front office scheduling experience not sufficient.