Job Description

Who We Are:

At Converge Medical Technology, we provide a comprehensive and transformational solution for people with chronic back and neck pain. Our approach is scientifically proven and evidence-based, bringing multidisciplinary treatment options into the homes of patients struggling with neck and back pain. We are dedicated to the genuine care and healing of our patients, striving to help them get back to doing the things they love. Our purpose is to enhance the lives of our patients and team members by fostering a culture of fun, family, and freedom.

Our Mission:

The genuine care and healing of our patients is our highest mission. Our goal is to help them get back to doing the things they love by providing cutting-edge, home-based treatment options.

Position Title: Medical Collections Specialist

Location: Austin, TX

Position Purpose: The Medical Collections Specialist role maintains the financial integrity of CMT Billing and Accounts Receivables by actively and reviewing and carrying out essential Billing and Collections functions.

Must have experience with Workers' Compensation claims, prior authorizations and comfortable working with Adjusters, Nurse Case Managers, and Claims reps.

Principal Accountabilities:

Essential duties and responsibilities include but are not limited to the following:

• Ensures accurate and timely billing of HCFA 1500 claims.
• Understands CPT, ICD10 and HCPC coding.
• Make outbound telephone calls to insurance companies for claims resolution.
• Follows existing billing/collection protocols to ensure accurate and timely reimbursement.
• Ensures that files are documented with appropriate information (i.e., date stamped, logged, signed, etc.).
• Collaborates/coordinates with Utilization Review for prior authorization/medical necessity documentation.
• Cross Trains in Utilization Review.
• Appeals denied claims, front in authorizations as well as back end denials.
• Calls insurance companies and uses carrier websites in collection efforts.
• Reviews accounts receivable accounts to ensure accurate reimbursement and Identify payor issues affecting payment delays.
• Responsible for the DME business aspects of arranging care regarding insurance verification, coverage limits and identifying and qualifying medical documentation requirements as applicable.
• Manage incoming referrals and maintain track of all inquiries and responses provided.
• Utilize Salesforce to conduct day-to-day business responsibilities according to standard operating procedures.
• Responsible for incoming and outgoing, high volume telephone calls acting as liaison for insurance companies and sales reps to process prior authorizations, appeals and updates.
• Research required information using available resources to complete referral submissions and updates.
• Must be able to work full business hours, 8:00am to 5:00pm M-F
• Abide by all HIPAA, Confidentiality and Privacy laws
• Other duties as assigned by the Manager as applicable.

Minimum Requirements/Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

At least 2-5 years of healthcare billing and collections/financial experience preferred. Working knowledge of CPT, ICD-10 coding. Must be a certified medical coder. High School diploma or equivalent required. Must have Worker’s Compensation experience. DME preferred but not required.

Language Skills

Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

Mathematical Skills

Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages. Ability to apply concepts of basic algebra and geometry.

Reasoning Ability

Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

Physical Demands

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.

While performing the duties of this job, the employee is regularly required to talk or hear.

Work 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. The noise level in the work environment is usually quiet.

Skills and Knowledge: – attention to detail; strong computer skills, and superior telephone communication skills at high volume throughout the day. Must have strong analytical skills.

Business Planning Establishes, develops, communicates and implements effective plans that align unit, department and individual contribution with CMT’s Mission/Vision and corporate goals.

Resource Management Acquires and deploys resources so as to maximize performance and value added, while effectively managing costs.

Focus on Customers: Aggressively seeks to anticipate, meet and whenever possible, exceed the needs and expectations of internal and external customers.

Shows Adaptability: Willing and able to adjust to rapidly changing priorities, multiple demands, and ambiguity.

Communication – Listen Attentively, Write Effectively, Speak with Impact: Communicates clearly, concisely and with sensitivity to the needs of others in all aspects of written and spoken communications.

Establish Relationships and Establish Trust : Fosters excellent achievement through teamwork.

Show Drive and Initiative and Manage and Improve Processes : Embraces innovation and change as healthy, and as a source of opportunity. Generates new ideas and approaches to solve problems and creates business opportunities, while maximizing existing resources.

Influence Others : Build give and take relationships; Exercise good judgment and timing; Develop and articulate compelling positions; Ensure your positions address others’ needs and priorities; Know whom to involve and when; build alliances and strive to create win-win situations.

Manage Execution : Establishes clear levels of action to achieve desired results on time and on budget / on KPI metrics.

Analyze Issues and Make Sound Decisions : Applies sound analysis and logic, balanced with creative and critical thinking to reach practical solutions and decisions.

Coach and Develop Others : Adopt a systematic approach to coaching; Build trusting coaching relationship; Understand what is important to people; identify strengths and development needs: Be a strong role model for development; create coaching and “Gap” plans; provide development assignments and goals; Effectively and efficiently discuss relevant feedback; reinforce a learning environment; and Increase people’s skills and business results.

Promote Collaboration and Teamwork : Demonstrates ability to align with the business objectives, enlist the commitment of stakeholders, and focus self and others on producing desired results.

Build Realistic Plans : Understand your organization’s strategic vision and tactical goals; Involve others in planning and identify and obtain resources needed to accomplish team or work group objectives: Identify action steps needed to accomplish team or work group goals; Establish clear realistic timelines for accomplishing goals; Identify risk and assumptions in plans, anticipate problems, and plan for contingencies.

Engage and Inspire: Encourages and enables others to achieve; creates a spirit of ownership, commitment and enthusiasm for the company, unit and work group, and the task at hand.

Converge Medical Technology is a talent-driven organization dedicated to recognizing and nurturing individual strengths. As part of our application process, you will be invited to complete a Talent Assessment , which helps us align your unique skills with the right opportunities. Upon completion, you will receive personalized feedback on your results providing valuable insights into your strengths. Join us and discover how your talents can thrive in an environment that values continuous growth and development.

To take the assessment, please click on the link below.

Job req code is 32000

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