Job Summary
This role is responsible for managing insurance claims, resolving outstanding balances, and ensuring timely reimbursement through effective communication with insurance payers and patients. The ideal candidate will have experience in soft collections, strong analytical skills, and a commitment to delivering high-quality service in a fast-paced healthcare environment.
Responsibilities
- Contact insurance companies to follow up on unpaid or delayed claims and ensure timely resolution.
- Review Explanation of Benefits (EOBs), remittances, and payer correspondence to identify and resolve discrepancies.
- Track and monitor account statuses, escalating problem accounts to the appropriate department when necessary.
- Maintain compliance with internal completion requirements and external regulatory standards.
- Meet or exceed productivity and quality benchmarks as defined by the department.
- Document all actions and communications in the patient’s account record accurately and thoroughly.
- Communicate with payers to resolve payer requests and discrepancies in a professional and empathetic manner.
- Apply soft collections techniques to encourage timely payment while maintaining positive relationships with payers.
- Adhere to the organization’s Code of Conduct, Mission and Values Statement, and all departmental policies and procedures
- Perform other duties as assigned.
Skills and Experience
- English – Spanish (oral and written 85% or higher), (B2+ or higher).
- Soft collections experience with the ability to handle sensitive financial conversations with empathy and professionalism.
- A minimum of one year of related experience, preferably in healthcare, is required. Relevant education may substitute for the experience requirement.
- Completed high school diploma.
- Good presentation and a polite, tactical, and friendly character.
- PC Skills: Demonstrates proficiency in Microsoft Office and other applications as required.
- The resource will adjust its local time with the resources that support this position during daylight saving time changes in the Eastern time zone.
- Excellent verbal and written communication skills.
- Strong problem-solving and analytical abilities.
- Close attention to detail and organizational skills.
- Ability to work independently and as part of a team in a fast-paced environment.
- Commitment to ethical standards and patient confidentiality.
- Effective time management to meet productivity goals and prioritize account collections.
- Ability to multitask and optimize idle time by progressing multiple accounts simultaneously.
- Experience in medical billing, insurance claims processing, or healthcare collections will be a plus.
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