Shalisha Green

Payer Collection Specialist Iii @Titan Health

Procedural KnowledgeUses A/R follow-up systems and reports to identify unpaid claims for collection/appeal.Gathers and verifies all information required to produce a clean claim including special billing procedures that a payer or contract may define.Review and update patient registration information (demographic and insurance) as needed.Prints and mails claim forms and statements according to the follow-up matrix.Retrieves supporting documents (medical reports, authorizations, etc) as needed and submit to third-party payers.Appeals rejected/denied claims and claims with low reimbursement.Confirm credit balances and gather necessary documentation for processing refund.Identifies insurance issues of primary vs. secondary insurance, coordination of benefits eligibility, and any other problem causing non-payment of claims.Contact the payors or patient as appropriate for corrective action to resolve the issue and receive payment of claims.(By phone or use of payer websites).Monitor invoice activity until the problem is resolved.Process daily mail, edit reports, file or pull EOB batches.Identifies and informs the supervisor / Production Unit Manager of issues or problems associated with non-payment of claims.Technical KnowledgeComprehensive knowledge and compliance with HIPAA rules and regulations in disseminating patient Protected Health Information (PHI).Working knowledge of JHU/ PBS Billing Applications.(Epic preferred)Utilize online resources to facilitate efficient claims processing.Professional & Personal DevelopmentParticipate in ongoing educational activities.Assist in the training of staff as applicable.Keep current with industry changes by reading assigned material on work-related topics.Complete three days of training annually.Service ExcellenceMust adhere to Service Excellence Standards.Customer RelationsSelf-ManagementTeamworkCommunicationsOwnership/AccountabilityContinuous Performance Improvement