Claims Collections Representative, Value-Based Care (VBC)

The Claims Collections Representative, Value-Based Care (VBC), plays an important role in resolving complex accounts receivable and outstanding claims associated with value-based care and bundled payment arrangements.

This position researches and reconciles accounts, investigates unresolved claims, navigates payer requirements, and works to ensure appropriate and timely reimbursement.

Responsibilities:

• Research and resolve complex claims and accounts receivable involving value-based care, bundled payments, and other healthcare reimbursement models.
• Analyze claims, payment variances, payer requirements, and contract terms to identify issues and drive resolution.
• Investigate account discrepancies and complete necessary corrections and adjustments.
• Work with payers, provider offices, clients, patients, and internal teams to resolve claims and reimbursement issues.
• Verify insurance, eligibility, and benefit information and ensure accurate payment posting.
• Prepare and submit appeals with appropriate medical records and supporting documentation.
• Identify reimbursement trends, recurring issues, and opportunities to improve claims resolution and collection processes.
• Support team initiatives, special projects, and other responsibilities as needed.

Requirements:

• Minimum of 3 years of experience in medical collections, revenue cycle, accounts receivable, or healthcare reimbursement.
• Experience researching and resolving claim denials, underpayments, payment discrepancies, and other complex reimbursement issues.
• Working knowledge of managed care contracts, payer policies, medical terminology, and healthcare reimbursement practices.
• Strong analytical and critical thinking skills with the ability to investigate account issues and interpret complex reimbursement and payment scenarios.
• Excellent verbal and written communication skills with the ability to clearly communicate complex claims and reimbursement information to payers, providers, clients, and internal teams.
• Ability to work independently, take initiative, solve problems, and exercise sound judgment with minimal supervision.
• Proficiency with Microsoft Excel, Outlook, and Word, including using Excel to review data and identify trends.

The potential base pay range for this role, when annualized, is $37,400.00 - $93,600.00.