Collection Specialist - Oldsmar, United States - Pinnacle Home Care

Pinnacle Home Care Oldsmar, United States

3 weeks ago

Description

** Collection Specialist - Home Care**

**Job Category****:** Operations **Requisition Number****:** MEDIC004006 Showing 1 location **Job Details**

**Description**

**Short Description:**

Responsible for obtaining, managing accurate, timely completion of all billing, collections, accounts receivable functions of the organization.

**ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES**

Request authorization for services within 24 hours of receiving request.

Follow up on pending authorizations.

Grant office authorization as needed for scheduled visits pending authorization timely and appropriately.

Calculate expected reimbursement percentages based on contracted rates and properly notate accounts.

Reconciles and collects on assigned accounts.

Meet productivity goals as assigned by the Billing/Reimbursement Manager.

Utilize appropriate systems to actively contact Payers/Patients for account transactions.

Ensures that all reconciled items and past due balances are resolved to completion through contact and follow-up with Payers/Patients.

Communicates professionally with inter-company departments on resolution of potential disputed items.

Responds to all inquiries with a resolution to concerns and or discrepancies.

Assists in the training of all new A/R personnel when needed.

Complies with HIPAA regulations on all accounts

Follows Pinnacle Home Cares Attendance Policy.

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job related tasks other than those stated in this description.

**SKILLS REQUIRED**

Thorough understanding of episodic billing methodologies including PPS and PDGM.

Analyzing and reconciling complex issues and problems timely.

Constructively working when faced with high workloads and deadlines.

Following directions and respectfully request clarification when needed.

Identifying needs and opportunities and present them to the supervisor with recommended solutions.

Working independently with minimal supervision.

Preparing and analyzing appropriate reports and other business correspondence.

Maintaining a positive outlook at all times.

Communicating in a clear, precise, and hospitable manner

Fostering two - way communication

Addressing customer concerns in a courteous and timely manner.

Strong organizational and time management skills.

Use of relevant computer systems.

**Must be Proficient in the below Skills:**

Thorough understanding of PPS and PDGM billing and collections Methodologies

Performs all collection activities for Medicare and Non-Medicare Home Health episodical accounts, leading to the timely reimbursement of receivables using available resources including internal/external tools , payer portals/websites, and telephone.

Identifies and initiates appropriate action to resolve denied/rejected invoices in accordance to CMS/Payer guidelines.

Reviews EOB/Remits /analyzes and clears payment variances for all PDGM and PPS AR.

Submits adjusted and/or corrected bills, identifies possible refunds in accordance with payer guidelines and operating procedures.

Participates in payer webinars to stay up to date with payers changes/updates.

**Qualifications**

**Skills**

**Behaviors**

**:**

**Motivations**

**:**

**Education**

**Experience**

**Licenses & Certifications**

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