Job Description

Job Description

Job Description

Exciting Medical Collections Specialist Opportunity! Are you ready to take your career to the next level? At Converge Medical Technology, we provide game-changing technology with empowering personalized patient services as part of our supervised physical therapy program. The Medical Collections Specialist role maintains the financial integrity of CMT Billing and Accounts Receivables by actively and reviewing and carrying out essential Billing and Collections functions. The ideal candidate must have experience with Workers' Compensation claims, prior authorizations and comfortable working with Adjusters, Nurse Case Managers, and Claims reps.

Key Responsibilities:

• Initiate outbound calls to insurance companies for claims resolution.
• Appeal denied claims and manage both front-end authorizations and back-end denials.
• Utilize insurance carrier websites and Salesforce for efficient follow-up.
• Review and manage accounts to ensure timely and accurate reimbursement.
• Identify and resolve payor issues impacting payment delays.
• Handle the DME (Durable Medical Equipment) business aspects, including insurance verification, coverage limits, and necessary medical documentation.
• Coordinate with Utilization Review for prior authorization and medical necessity documentation.
• Manage high-volume inbound and outbound calls, acting as a liaison between insurance companies and sales representatives.
• Maintain thorough documentation of all communications and actions taken.
• Ensure accurate and timely submission of HCFA 1500 claims.
• Apply CPT, ICD-10, and HCPC coding knowledge effectively.
• Ensure compliance with HIPAA, confidentiality, and privacy regulations.
• Follow established billing and collection protocols for accurate reimbursements.
• Cross-train in Utilization Review to enhance departmental efficiency.
• Collaborate with internal teams to streamline referral management and prior authorizations.
• Conduct research using available resources to complete referral submissions and updates.
• Perform other related duties as assigned by the Manager.

Qualifications:

• High School diploma or equivalent required and 2-5 years of healthcare billing and collections/financial experience preferred.
• Working knowledge of CPT, ICD-10 coding.
• Must be a certified medical coder and have Worker's Compensation experience
• DME preferred but not required.
• Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
• Ability to write reports, business correspondence, and procedure manuals.
• Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
• Ability to calculate figures and amounts (such as discounts, interest, commissions, proportions, percentages) and apply concepts of basic algebra and geometry.
• Ability to define problems, collect data, establish facts, and draw valid conclusions including interpreting an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

Location: In Person in Austin, TX

Pay Range: $22- $24/hr

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