Surgery Partners, Inc

Collections

• The primary responsibility of the Medical Collection Specialist is to ensure effective collection of all patient accounts.
• Perform extensive insurance claim follow-ups for insurance denials, appeals, and perform next steps a must.
• Ability to utilize multiple patients accounting and billing applications including but not limited to claims clearing house systems, payer websites.
• Ability to interact with the payer representatives, HIM, Insurance Verification and Access Service departments.
• Participates in group meetings and /or various committees.
• Ability to effectively present information regarding denial trends, and present to management.
• Ability to read, understand, interpret and resolve payer denials and EOB's.
• Ensure denial reviews, claim follow-ups are conducted in a timely manner in accordance with payer timely filing limits.
• Correct claims and file appeals with supporting documents to insurance companies, by phone, electronically or mail.
• Ability to work receivables to investigate and resolve denials and partial payments.
• Ability to calculate reimbursement per payer contract.

Medical Collections Specialist

Call Center Representative

• Answer incoming calls and direct them to the right departments
• Accurately schedule appointments, consultations, and surgeries in NextGen
• Register new patients and input detailed demographic and insurance information
• Confirm appointments and verify insurance coverage
• Educate patients on pre-visit protocols, paperwork, and appointment details
• Take and route messages from patients, physicians, and pharmacies
• Coordinate scheduling for multiple physicians and locations
• Provide backup front office support and contribute to overall workflow
• Reach out to new patients with a friendly welcome call

Bilingual Call Center Representative – Medical Practice

Manager

• Responsible for performing prospective, concurrent, and post-discharge utilization reviews.
• Supports accurate admission status determinations and active denial management.
• Assists with discharge planning activities and contributes to performance improvement initiatives.
• Conducts comprehensive medical record reviews and ensures compliance with hospital policy and regulations.
• Facilitates appropriate admission status determinations based on clinical documentation and payer requirements.

Medical Collections Specialist

Bilingual Call Center Representative – Medical Practice

RN Case Manager – Utilization Review