Collections Specialist - Patient Accounts II


The Medicaid Collector-Patient Accounts II serves as the secondary gatekeeper for the Nexus Health Systems Business Office. This position is responsible for handling Central Business Office incoming telephone calls, correspondence, and patient account documentation for accounts assigned aged 61+. Position confirms the patient financial folder contains the completed and appropriate billed claims; billing account documentation supports the expected reimbursement per the contract for timely and accurate collections. The position creates Federal and State mandated reporting.


1. Responds to telephone calls, working with those that are routine in nature, or routing the appropriate staff member as calls occur.

2. Confirms admission documentation from the facilities and the CBO biller; the claim documentation is accurate compared to the assigned payer per contract guidelines.

3. Communicates internally/externally to obtain additional patient information to collect timely and per the contract.

4. Confirms claims were billed and received for accounts assigned.

5. Confirm patient financial folders are assembled and maintained sequentially. Confirm claims were billed and correspondence matches to the appropriate patient account when filing completed EOB’s.

6. Requests rebill claims as payers identify no claim on file or claim denied by providing appropriate requests to billers. Obtain complete information from the payer to rectify and allow claims to be billed correctly and timely via paper and/or electronic to have claims reimbursed timely.

7. For claims submitted timely and accurately that remain unpaid past the contract requirements must be pursued for 100% of total charges.

8. Confirm claims submitted electronically have been received with no rejections.

9. Claims rejected or not confirmed received are to be requested from the biller immediately. Provide information to ensure the claim is submitted correctly to the biller. Mandatory to work and collect on estimated 35 accounts per day. Account documentation required.

10. Document payment, adjustment, patient responsibility daily as EOB’s are received or verified electronically.

11. Submit Adjustments within 24 hours of receipt of posting payments or receiving EOB’s. The claim must be resolved within the same month the payment is posted.

12. Document collection efforts taken on each account billed for claims aged 60+ days. Collections or billing confirmation can be obtained via phone call to the payer, lockbox, or online. All actions taken must be noted.

13. Mandatory to work 35+ accounts from aging daily.

14. Prepares and summarizes accounts actions for accounts aged 90+ for monthly CEO AR call.

15. Responds to correspondence within 24 hours from the date of receipt.

16. Communicates with facility personnel to coordinate patient documentation required to appeal or rectify payments.

17. Forward denial correspondence to the appropriate staff to assist with appeals.

18. Files all bills, appeals, communication to each patient/claim appropriately in the patient chart.

19. Identify credit balances monthly and prepare adjustments to refund appropriate credits before the end of each month for Federal and State-funded agencies. (Medicare, Managed Medicare, Medicaid, Managed Medicaid, DARS).

20. Credit balances on non-Federal or State Funded claims are to be prepared on the adjustment sheets and forwarded to Refund Pending, waiting for refund request from payers.

21. Work accounts assigned on aging twice per month. Follow-up required every 7-14 days, depending on how the claim was billed.

22. Pull paid accounts monthly from patient files to box and store. Confirm the file is complete and in order before boxing in the event the file is reviewed during any audit processes.

23. Identify any internal/external changes, processes, procedures, etc., that may create reimbursement issues.

24. Assists other CBO employees as necessary.

25. Performs all other duties as assigned.

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Job Requirements


  • Minimum of 3 years of experience in a hospital business office setting, or at least one year of experience in the medical billing/collection field.

Education Required

  • A high school diploma is required
  • One to two years college preferred.