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BrightSpring Health Services

Home-based health services and pharmacy solutions

Medical Collections Lead

Accounts Payable/ReceivablePosted on Nov 12
Full-timeCentennial, CO, USA

About the Job

Requirements

  • A high school diploma, GED, or equivalent is required; some college is a plus.
  • At least one year of experience in medical collections, with working knowledge of managed care, commercial insurance, and Medicare and Medicaid reimbursement.
  • Working knowledge of automated billing systems; experience with CPR+ is preferred.
  • Working knowledge and application of metric measurements, basic accounting practices, ICD-9, CPT, and HCPCS coding.
  • Solid Microsoft Office skills, including Word, Excel, and Outlook.
  • Ability to type 40 words per minute and proficiency with a 10-key calculator.
  • Ability to independently obtain and interpret information.
  • Strong verbal and written communication skills.
  • Ability to sit and talk or hear regularly; walk and use hands to finger, handle, or feel frequently; and stand and reach occasionally.
  • Ability to frequently lift or move up to 10 pounds and occasionally lift or move up to 30 pounds.
  • Close vision, distance vision, and ability to adjust focus.

Responsibilities

  • Monitor and perform activities related to collection of accounts receivable and denials, including Medicare, Medicaid, commercial insurance, and patient balances.
  • Serve as the initial resource for questions from other collectors in the department.
  • Work assigned accounts proactively to maximize accurate and timely payment.
  • Work with collectors and management to identify and share trends or patterns in denials and payment activity.
  • Ensure the collection department complies with company policies and applicable laws and regulations for billing, collections, banking, and security of patient financial information.
  • Ensure daily work supports cash-collection goals by ensuring accounts receivable over 60 days are worked accurately by aging teams and denied claims are worked within seven days of a posted denial by the denials team.
  • Assist with collections through accounts-receivable analysis and denial resolution, and assist with receiving, batching, posting, balancing, and archiving payments and adjustments to accounts receivable.
  • Ensure the collection department meets established company criteria for timely and accurate billing and collections.
  • Research denials and outstanding balances, take necessary collection action to resolve them promptly, and make demographic changes to patient accounts to support future collections.
  • Use efficient resources to secure timely payment of open claims or invoices, prioritizing electronic solutions.
  • Review insurance remittance advices for accuracy; identify billing errors, short payments, overpayments, and unpaid claims; resolve issues and communicate needed system changes.
  • Review residual account balances after payments and generate necessary adjustments within eligible guidelines, overpayment notifications, refund requests, or secondary billing as needed.
  • Monitor payer websites for updates and communicate accordingly; recommend billing procedure changes to support timely claim payment.
  • Review and post adjustments of $499 or less within eligible guidelines.
  • Identify inefficient processes and recommend automation or elimination.
  • Identify denial trends and patterns in short payments, overpayments, or nonpayment and bring them to the appropriate specialist's attention.
  • Perform quality-assurance audits of accounts-receivable management and evaluate collector performance.
  • Contact payers by telephone, mail, email, or other appropriate means to obtain copies of missing remittance documents as needed.
  • Monitor adherence to state and federal regulations and company policies on compliance, integrity, patient privacy, and ethical billing and collection practices.
  • Assist in implementing a training program for Collection Specialists and Patient Collection Specialists.
  • Coordinate and conduct training for new staff.
  • Assist with competency testing for training materials.
  • Interact with third-party collection agencies as needed.
  • Understand and adhere to HIPAA and protected health information guidelines.
  • Communicate clearly and professionally in writing and orally with internal and external customers.
  • Work extended hours when necessary to meet department deadlines.
  • Perform other tasks or special projects as requested by management.

Desired Qualifications

  • Home infusion experience is a plus.
  • Experience with CPR+ is preferred.

About the Company

BrightSpring Health Services

Home-based health services and pharmacy solutions

BrightSpring Health Services delivers home and community-based health services for people with complex or chronic needs, organized into two segments: Pharmacy and Provider. The Pharmacy segment provides specialty, infusion, and community pharmacy services to patients with complex conditions. The Provider segment offers behavioral health, home health, hospice care, and services for individuals with intellectual and developmental disabilities. The company runs an integrated care model through a network of pharmacies and providers to support a continuum of care that includes clinical services, care coordination, and in-home support. Revenue comes from Medicare, Medicaid, and private insurance, reflecting reimbursement across public and private payers. The goal is to coordinate pharmacy and in-home health services to improve access, continuity, and outcomes for patients and to serve managed care organizations with a complete care solution.

Company size
10,001+
Company stage
IPO
Headquarters
Lyndon, KY
Founded
1974

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