PFS Collection Specialist

Overview Responsible for collecting commercial, government, and patient balances by following the approved processes, policies and procedures set by the revenue cycle department. Responsibilities Monitors outstanding account balances to determine the next step in the collection process. Follows up on claims and claim denials to ensure maximum reimbursement for services provided. Reviews accounts receivable activities and calls on outstanding balances or claims. Generates appropriate paperwork, including insurance claim forms (original and re-filed) and collection letters. Reviews insurance payments (Explanation of Benefits – EOB’s) to determine whether reimbursement is accurate. Navigate portals to send claims for adjudication. Investigates and appeals denied or underpaid claims. Responds to all inquiries received from patients and payors either by telephone or written request. Tracks and resolves discrepancies. Follows-up on unpaid insurance claims after denial to obtain settlement of claim. Audit insurance and patient accounts to determine whether a refund is needed. Promptly and courteously responds to all inquiries received from payors and patients either by telephone or written request. Provides clear communication and customer service on collection issues to external customers and internal business partners. Helps patients develop patient payment plans. Identifies patterns and trends that indicate a potential issue. Adheres to all policies and procedures in performing j