ASC Business Office Staff Tasklists: Collections Specialist

These tips, part of an ongoing series that identifies ASC business office staff positions and provides suggested responsibilities for auditing purposes and evaluating employee progress, focus on the Collections Specialist.

Collections Specialist

1. Understands:

• Third-party payer contract language

• Individual managed care contract coverage amounts

• State prompt-payment regulations

• Each contract’s reimbursement turnaround times

Concerning Third-Party Payer Accounts

2. Follows up on claim progress (e.g. first follow-up in approximately two weeks, thereafter additional follow-ups conducted at least every 30 days until resolution).

3. Uses “aging report by payer” on a weekly basis to identify and contact delinquent payers.

4. Develops protocol for handling delinquent payers.

5. Develops a method of tracking denials to identify trends.

6. Becomes familiar with the terms in payer contracts (e.g. requirements for timely filing, appeals, claim corrections and the state’s prompt payment regulations). Enforces these with payers.

7. Immediately responds to payer requests for additional information (e.g., operative notes, invoices).

8. When necessary, copies state insurance commissioner for improperly paid claims or claims not paid in a timely manner.

9. If indicated, considers involving the payer's provider representative regarding reimbursement issues.

10. Asks pertinent questions of payers that require more than a form letter response.

11. Documents all correspondence (letters, e-mails, telephone calls) with payers. Includes date, name of payer representative and any actions taken or promised by payer.

12. Customizes appeal letters and always include supporting documentation.

13. Always take appeals to highest level of adjudication.

Concerning Patient Accounts

14. Runs reports on outstanding patient accounts receivable (A/R) on a daily/weekly basis.

15. Checks with patient biller to determine whether any special payment arrangements exist.

16. Makes telephone or letter contact with all patients with balances more than 45 days old with no payment.

17. Notes contact with patients in software.

18. Submits any new payment arrangements to business office manager for approval.

19. For patient account balances of more than 90 days with no payment, advises business office manager, who will determine whether account is to be turned over for collection.

20. Sends approved accounts to collection agency.

21. Monitors collection agency report of payment on a regular basis and calls collection agency for information on worked accounts.

22. If it is determined that a refund is due to the insurance company, completes refund-request form with supporting documentation, copy of explanation of benefits (EOB), etc., and submits to business office manager.

The next set of tips in this series will focus on the Payment Poster. Access other tips in this series on ASC business office staff tasklists.

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