Self Pay Collections Specialist
As a Self Pay Collections Specialist, you will be a part of the finance and accounting team. Reporting to the Revenue Cycle Manager, the Self Pay Collections Specialist will be a key member of a team and responsible for ensuring the success and accuracy of our technology driven member’s post adjudication collections workflow. This role is crucial to understand and resolve post adjudication balances, and partner with our self pay vendor to offer support in resolution of member balances.
Duties/Responsibilities:
- Monitor the health of our claims post adjudication self pay balances prior to 60 days aged.
- Support our self pay vendor for our 60+ aged self pay AR.
- Be the go-to person for post adjudication balance questions, including participating in cross-functional efforts to increase efficiency of systems and processes related to the revenue cycle.
- Perform in depth research to look for trends in our invoice balances to propose reconciliation both internally and with external vendors.
- Work with Product, Engineering, Finance, and Operations to close gaps within our self pay collection issues. EX: troubleshoot ways to ensure we are collecting member responsibility on the front end whenever possible.
- Perform required monthly reconciliation processes.
- Ensure all self pay payments are posted to accounts accurately.
- Represent Included Health during discussions with stakeholders. Work with CSMs where necessary to correct any cost share/RTE issues identified.
- Monitor and implement best practices necessary for a healthy member collections experience.
- Verify and process member credits. Perform a reconciliation process monthly to ensure credits are posted correctly.
Required Skills/Abilities:
- Ability to consistently comb through large amounts of data and draw insights from it.
- High standards of accuracy and precision.
- Understanding of insurance plan benefit design, as well as ANSI 5010 837 and 835 files.
- Excellent analytical and quantitative abilities.
- Excellent verbal and written communication skills.
- Capable of presenting complex claims billing workflow information in an easy to understand format.
- Can work with employees at all levels of the organization in a highly collaborative environment.
- Preferred: Strong technical acumen (understanding of JSON, XML, X12/EDI, SQL, system configuration management, and database structures). Experience with business intelligence tools can be a substitute for this.
Education and Experience:
- Three (3) years of progressively responsible and directly related work experience.
- 2+ years of relevant revenue cycle operations experience, patient financial services and/or health information systems preferred. 1-2 years of statistical analysis experience.
- 1-2 years Medical Billing experience.
Physical Requirements:
- Ability to remain seated in a stationary position for prolonged periods.
- No heavy lifting is expected, though occasional exertion of about 20 lbs. of force (e.g., picking up and computer / laptops) may be required.
- Good manual dexterity required to use common office equipment (e.g., computers, laptop, and mobile devices).
- Some overnight business travel may be required.
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About Included Health
Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included. Learn more at includedhealth.com.
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Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants in accordance with the San Francisco Fair Chance Ordinance.