Medical Insurance Collector

Medical Insurance Collector

The Medical Insurance Collector is required to collect complex denials, prepare appeals, and take other necessary actions on outstanding balances for BCBS, UHC, Aetna/Cigna, and self-funded/commercial providers in the professional/facility fee environment. Our facilities are out-of-network with all payers.

To succeed, you must possess in-depth knowledge of collection processes and medical insurance policies. The ideal candidate must also demonstrate excellent written and verbal communication skills, as they will communicate with various insurance companies and customers. This position requires an individual who can multi-task, problem-solve, and manage time effectively.

Job Requirements/Qualifications

• MUST HAVE 3 YEARS OF MEDICAL INSURANCE COLLECTION EXPERIENCE WITH AN EMPHASIS ON MEDICARE INSURANCE COLLECTIONS.

• 3 - 4 years of previous billing experience, with emphasis on Medicare billing

• Organized, self-sufficient, analytical, and detail-oriented.

• STRONG knowledge of insurance plan providers- BCBS, UHC, Aetna/Cigna, and self-funded/commercial providers required.

• Knowledge of Electronic Medical Records, Collections, Payment Posting, Reimbursement, Billing, and Hospital Experience

• REQUIRED Knowledge of EOBs, HIPAA, ICD-10 codes, and CPT codes

• Knowledge of payer systems

• Experience in the DDE system and Novitasphere

• Working knowledge of the CMS 838 credit balance report

• Once remote transition is completed, you must be able to work from home effectively.

• Preference shown to previous experience in a Facility setting.

• Function as a subject matter expert (SME) for Medicare

• Function as a subject matter expert (SME) for the following appeals:

• Clinical

• Medical Necessity

• Authorization

• Non-Covered

• Underpayments

Essential Job functions and responsibilities

• Investigates and responds to inquiries from payors.

• Research errors and makes corrections for clean claim production and submissions.

• Follow-up on accounts to ensure timely filing and prompt payment.

• Actively review billing/collection policy changes for assigned payers.

• Follow up on payment errors, review posting, and calculate allowable amounts before approving patient statements.

• Review insurance EOBs and initiate appeals as necessary

• Resolves all insurance requests, inquiries, and concerns expediently and respectfully.

• Work accounts to ensure payment meets the qualified payment amount required by the No Surprises Act

• Must think outside the box; critical decision-making is necessary to fulfill the position’s expectations.

• Meet and exceed departmental goals set by the company and department manager.

Nutex Health is the premier innovative service provider in the emergency care industry. Our specialists provide unparalleled expertise with the knowledge and competency to make your vision a reality. You can trust Nutex Health to deliver a turnkey process from real estate acquisition, design, and development of the ER facility to staffing, training, and operations.

EEO & Accommodation Statement

Nutex Health is committed to providing equal employment opportunity and all qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, genetic information, national origin, age, disability, status as a protected veteran, or membership in any other class protected by federal, state, or local law.

Requirements

General Job Requirements

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