CTG CLAIMS RECOVERY COLLECTOR in Irving, Texas
Title: CLAIMS RECOVERY COLLECTOR
Job Number: 19205234
HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to
healthcare—now and in the future. Using innovative technology and powerful data analytics, we help government and
commercial payers reduce costs, increase quality, and achieve regulatory compliance. We also help consumers take a
more active role in their own health. Each year, we save our clients billions of dollars while helping people live healthier
lives. At HMS, you will develop new skills and build your career in a dynamic industry while making a difference in the
lives of others.
We are seeking a talented individual for a Claims Recovery Collector I who is responsible for recovering payments from
commercial insurance carriers who should have paid primary to the Medicaid agency.
Confer with carriers by telephone or use Web sites to determine member eligibility and claim status.
Assess denials, pursue appeals or close claims when appropriate.
Update case management system with proper noting of actions and appeal/denial information.
Respond to carrier telephone, fax and e-mail inquiries regarding outstanding claims.
Sort and file correspondence.
Mail form letters to carriers to affect payment of outstanding claims.
Contact providers to obtain additional information and/or documentation to resolve unpaid claims.
Manage a weekly aging report.
Responsible for achieving high recoveries against a portfolio of claims.
Work with document imaging system for archival purposes.
Ensure that payers adhere to laws regarding timely filing of claims.
Pursue each outstanding account to reach maximum reimbursement by working with subject matter experts to resolve
Develop recovery strategies with each payer.
May have some training responsibilities limited to projects and specific tasks
- Performs other functions as assigned
Qualifications - External
Knowledge, Skills and Abilities:
Strong understanding of third-party billing and/or claims processing.
Ability to use critical thinking skills.
Possess good customer service skills.
Ability to adapt to change.
Ability to manage time effectively and multi-task.
Ability to prioritize work.
Ability to perform basic calculations.
Ability to work proficiently with Microsoft Windows, Word and have basic knowledge of Excel.
Average manual dexterity in use of a PC, phone, sorting, filing and other office machines.
Ability to be detail oriented.
Ability to learn and follow HIPAA privacy and Security rules.
Ability to work independently to meet predefined production and quality standards.
Ability to perform well in a team environment to achieve business goals.
Work Conditions and Physical Demands:
Primarily sedentary work in a general office environment
Ability to communicate and exchange information
Ability to comprehend and interpret documents and data
Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.)
Requires manual dexterity to use computer, telephone and peripherals
May be required to work extended hours for special business needs
May be required to travel at least 10% of time based on business needs
- High School Diploma or GED required, Associates degree preferred
Minimum Related Work Experience:
- > 2 yrs experience with third party institutional billing, >1 yr experience handling claims appeals, Ability to interpret an
Explanation of Benefits (EOB) and UB-04 claim form required; DSM-IV, CPT, HCPCS, and CMS-1500 preferred
Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at
CTG (NASDAQ: CTG) provides industry-specific IT services and solutions that address the business needs and challenges of clients in high-growth industries in North America and Western Europe. CTG also provides strategic staffing services for major technology companies and large corporations. Backed by more than 50 years of experience and proprietary methodologies, CTG has a proven track record of reliably delivering high-value, industry-specific staffing services and solutions to its clients. CTG has operations in North America, Western Europe, and India.
CTG's greatest asset is its people, and as such, we are committed to providing employees programs and processes to support their performance, hone their skills, and advance in their careers. This commitment is reflected by CTG being named a Best Places to Work in Healthcare company by Modern Healthcare (2013-2016) in North America, and a Best Workplace in the United Kingdom (2013), Belgium (since 2007), and Luxembourg (since 2011).
CTG will consider for employment all qualified applicants including those with criminal histories in a manner consistent with the requirements of all applicable local, state, and federal laws.
CTG is an Equal Opportunity/Affirmative Action Employer and strong advocate of workforce diversity. Minority/Female/Sexual Orientation/Gender Identity/Disability/Veteran.
Job: Skilled Labor / Trades