Position Overview: Reporting to the Client Operations Manager, the Revenue Cycle Specialist - Collector must have a strong knowledge of medical collections, accounts receivables, insurance billing and verification, denial processing, appeal submission and EOB review. This position is responsible to resolve outstanding surgical claims resulting in maximum reimbursement. Responsibilities: - Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers including self-pay to obtain maximum reimbursement. - Manage daily work queue to prioritize high dollar claim balances. - Review & work incoming insurance and patient correspondence including refund requests. - Send appeals when appropriate or provide the requested medical documentation. - Ability to review medical documentation to justify medical necessity. - Review patient balances to ensure accuracy and follow up with patients to obtain payments. - Take incoming patient phone calls to resolve inquiries, billing issues, or outstanding balances. - Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents. - Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD’s) for claim resolution. - Negotiate payment amounts for procedures with Third Party Administrators for out of network providers. - Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.

Position Overview: Reporting to the Client Operations Manager, the Revenue Cycle Specialist - Collector must have a strong knowledge of medical collections, accounts receivables, insurance billing and verification, denial processing, appeal submission and EOB review. This position is responsible to resolve outstanding surgical claims resulting in maximum reimbursement. Responsibilities: - Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers including self-pay to obtain maximum reimbursement. - Manage daily work queue to prioritize high dollar claim balances. - Review & work incoming insurance and patient correspondence including refund requests. - Send appeals when appropriate or provide the requested medical documentation. - Ability to review medical documentation to justify medical necessity. - Review patient balances to ensure accuracy and follow up with patients to obtain payments. - Take incoming patient phone calls to resolve inquiries, billing issues, or outstanding balances. - Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents. - Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD’s) for claim resolution. - Negotiate payment amounts for procedures with Third Party Administrators for out of network providers. - Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.

Position Overview: Reporting to the Client Operations Manager, the Revenue Cycle Specialist - Collector must have a strong knowledge of medical collections, accounts receivables, insurance billing and verification, denial processing, appeal submission and EOB review. This position is responsible to resolve outstanding surgical claims resulting in maximum reimbursement. Responsibilities: - Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers including self-pay to obtain maximum reimbursement. - Manage daily work queue to prioritize high dollar claim balances. - Review & work incoming insurance and patient correspondence including refund requests. - Send appeals when appropriate or provide the requested medical documentation. - Ability to review medical documentation to justify medical necessity. - Review patient balances to ensure accuracy and follow up with patients to obtain payments. - Take incoming patient phone calls to resolve inquiries, billing issues, or outstanding balances. - Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents. - Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD’s) for claim resolution. - Negotiate payment amounts for procedures with Third Party Administrators for out of network providers. - Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.

Job DetailsJob Location: IL Regional Office - Springfield, IL 62794-9277Position Type: Full-TimeEducation Level: Bachelor's DegreeJob Shift: DayJob Category: Administrative & ClericalSalary up to $100k (depending on experience) Centurion is proud to be the provider of comprehensive services to the Illinois Department of Corrections. We are currently seeking a Full-time CQI Specialist to join our Regional Office team in Springfield, Illinois. This is a remote/traveling position. Candidates must reside in Illinois and live a commutable distance to our regional office for meetings and site visits as needed. Based out of the regional office, the Statewide CQI Specialist develops and implements the Continuous Quality Improvement (CQI) program in accordance with the mission and strategic goals of the company, federal and state laws and regulations, accreditation standards and specific contractual requirements. Qualifications Licensure as a RN or Bachelor’s Degree (Master’s Degree preferred) in a clinical or allied health field from an accredited institution required Certification as a Professional in Healthcare Quality (CPHQ) preferred Minimum of two years of experience in health information, quality, utilization or risk management Minimum of two years of experience in Quality Assurance/ Continuous Quality Improvement preferred Knowledge of statistics, data collection, analysis and data presentation Skilled in use of computer software for maintaining statistics and developing reports Excellent problem solving and writing skills Experience in a correctional setting preferred Must be appropriately and actively certified in Cardio-Pulmonary Resuscitation (CPR) Ability to obtain a security clearance, to include drug screen and criminal background check We offer excellent compensation and comprehensive benefits for our full-time team members including: Health, dental, vision, disability and life insurance 401(k) with company match Generous paid time off Paid holidays Flexible Spending Account Continuing Education benefits Much more...