The HME Collections Specialist is responsible for managing and resolving outstanding accounts receivables for patients and insurance companies in the home medical equipment industry. This role ensures timely and accurate billing and collection processes, maintains compliance with healthcare regulations and provides exceptional customer service to resolve payment issues.
MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. High school diploma or equivalent.
2. Current valid driver’s license.
EXPERIENCE:
1. Two (2) years’ experience working with collections, billing, or accounts receivable.
PREFERRED QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Associate’s Degree or Bachelor’s degree in business, healthcare or related field.
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
1. Monitor and manage accounts receivable reports, ensuring proper resolution of held or stopped claims to maintain cash flow and reduce outstanding balances.
2. Ensure claims are submitted within timely filing limits and implement strategies to address stop-gap issues that may delay reimbursement.
3. Process and update insurance information for existing patients with continuous rentals or periodic resupply needs to ensure accurate billing and claims submission.
4. Maintain current recertifications, prescriptions, and prior authorization for rental and period resupply patients ensuring compliance with payer requirements and uninterrupted equipment rentals.
5. Manage monthly billing for hospice accounts and quarterly billing for medical equipment facilities, ensuring timely and accurate submissions.
6. Analyze denial trends and collaborate on special projects to identify root causes and implement remediation strategies for claim resolution.
4. Monitors and verifies oxygen cylinder issues. Verifies Lot numbers and quantities are correct. Reports any deficiencies immediately to cylinder provide and obtain resolution. Performs random audits of lot numbers to verify tracking process is being followed.
5. Supports inventory management by performing visual checks and ensuring stock levels meet requirements.
6. Communicates with vendors to ensure timely shipment and resolve issues.
7. Maintains accurate records of serialized rental assets.
8. Researches special order requests and parts for patient owned equipment. Provides to pricing and HCPCS to appropriate staff to determine insurance coverage prior to ordering.
9. Tracks and reports on the concentrator preventive maintenance program including caped Medicare rental billing for maintenance at the appropriate interval.
10. Responsible for oxygen, equipment, and supply recalls following policy. Communicates promptly with management and staff regarding process to follow. Tracks and reports updates continually until recall is complete.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Position requires some heavy lifting.
2. Requires functional range of body mobility including; handling and lifting, manual and finger dexterity and eye-hand coordination sufficient to assist patients and/or customers and/or to handle and use required instruments, machinery/tools with moving parts.
3. Requires corrected vision and depth perception sufficient to identify and discern the printed words instruments and instructions and ability to record and communicate appropriate documentation.
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1.May be exposed to fluctuating temperatures.
SKILLS AND ABILITIES:
1. Strong communication skills.
2. Maintains knowledge of current trends with health care reform and reimbursement changes
3. Possess good interpersonal skills, organization, and leadership skills.
4. Ability to work independently and as part of a team.
Additional Job Description:
Scheduled Weekly Hours:
0
Shift:
Exempt/Non-Exempt:
United States of America (Non-Exempt)
Company:
SHC WVUHS Home Care
Cost Center:
500 SHC Administration
The West Virginia University Health System, which operates under the brand WVU Medicine, is West Virginia’s largest health system and the state’s largest employer with more than 3,400 licensed beds, 4,600 providers, 35,000 employees, and $7 billion in total operating revenues. The Health System is comprised of 25 hospitals – including J.W. Ruby Memorial Hospital, an 880-bed academic medical center, and the 150-bed WVU Medicine Golisano Children’s Hospital in Morgantown, West Virginia – and five institutes. To learn more, visit WVUMedicine.org.
