Collections

4 weeks ago

Irvine, United States Spherion Full time
The Medical Collector serves as Hoag's account representative, working with insurance companies, government payors, and patients to resolve payments and accounts. The ideal candidate will have thorough knowledge of healthcare billing practices, insurance plans, and regulatory requirements, as well as excellent communication and problem-solving skills.

Responsibilities:
-The Collector serves as the account representative for Hoag in working with insurance companies,government payors, and/or patients for resolution of payments and accounts resolution.
-Completes assigned accounts within assigned work queues.
-Obtains the maximum amount of reimbursement by evaluating claims at the contract rate with the use of the contract management tool for proper pricing (Examples: APC, DRG, APRDRG).
-Reviews and initiates the initial appeal for underpayments observing all timely requirements to secure reimbursement due to Hoag.
-Reviews and completes payor and/or patient correspondence in a timely manner.
-Escalates to the payor and/or patient accounts that need to be appealed due to improper billing, coding and/or underpayments.
-Reports new/unknown billing edits to direct supervisor for review and resolution.
-Has a strong understanding of the Revenue Cycle processes, from Patient Access (authorizations admissions) through Patient Financial Services (billing & collections), including procedures and policies.
-Has thorough knowledge of managed care contracts, current payor rates, understanding of terms and conditions, as well as Federal and State requirements.
-Interprets Explanation of Benefits (EOBs) and Electronic Admitt ance Advices (ERAs) to ensure proper payment as well asassist and educate patients and colleagues with understanding of benefit plans.
-Understanding of hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms.
-Knowledge ofHMO, POS, PPO, EPO, IPA, Medicare Advantage, Covered California (Exchange), capitation,commercial and government payors (i.e. Medicare, Medi-Cal, TriCare, etc) and how these payors process claims.
-Demonstrates knowledge of and effectively uses patient accounting systems.
-Documents all calls and actions taken in the appropriate systems.
-Accurately codes insurance plan codes.
-Establishes a payment arrangement when patients are unable to pay in full at the time payment is due.
-May review for applicable cash rates, special rates, applicable professional and employee discounts.
-May process bankruptcy and deceased patient accounts.
-Performs other duties as assigned.

Working hours: 8:00 AM - 5:00 PM

Skills:
-One year of previous hospital business experience, or equivalent required or strong background in customer service.
-Basic experience with insurance plans, hospital reimbursement methodology, and/or ICD10 and CPT coding.

Education:
No Degree Required

Experience:
4-7 years

Qualifications:
-EPIC Software

Looking to fill hospital positions



Spherion has helped thousands of people just like you find work happiness Our experienced staff will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temp-to-perm or direct hire opportunities, no one works harder for you than Spherion.

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Spherion, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact Callcenter@spherion.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Spherion offers a comprehensive benefits package, including health, and an incentive and recognition program (all benefits are based on eligibility).
Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.

key responsibilities

-The Collector serves as the account representative for Hoag in working with insurance companies,government payors, and/or patients for resolution of payments and accounts resolution.-Completes assigned accounts within assigned work queues.-Obtains the maximum amount of reimbursement by evaluating claims at the contract rate with the use of the contract management tool for proper pricing (Examples: APC, DRG, APRDRG).-Reviews and initiates the initial appeal for underpayments observing all timely requirements to secure reimbursement due to Hoag.-Reviews and completes payor and/or patient correspondence in a timely manner.-Escalates to the payor and/or patient accounts that need to be appealed due to improper billing, coding and/or underpayments.-Reports new/unknown billing edits to direct supervisor for review and resolution.-Has a strong understanding of the Revenue Cycle processes, from Patient Access (authorizations admissions) through Patient Financial Services (billing & collections), including procedures and policies.-Has thorough knowledge of managed care contracts, current payor rates, understanding of terms and conditions, as well as Federal and State requirements.-Interprets Explanation of Benefits (EOBs) and Electronic Admitt ance Advices (ERAs) to ensure proper payment as well asassist and educate patients and colleagues with understanding of benefit plans.-Understanding of hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms.-Knowledge ofHMO, POS, PPO, EPO, IPA, Medicare Advantage, Covered California (Exchange), capitation,commercial and government payors (i.e. Medicare, Medi-Cal, TriCare, etc) and how these payors process claims.-Demonstrates knowledge of and effectively uses patient accounting systems.-Documents all calls and actions taken in the appropriate systems.-Accurately codes insurance plan codes.-Establishes a payment arrangement when patients are unable to pay in full at the time payment is due.-May review for applicable cash rates, special rates, applicable professional and employee discounts.-May process bankruptcy and deceased patient accounts.-Performs other duties as assigned.

experience

4-7 years

skills

-One year of previous hospital business experience, or equivalent required or strong background in customer service.-Basic experience with insurance plans, hospital reimbursement methodology, and/or ICD10 and CPT coding.

qualifications

-EPIC Software

education

No Degree Required

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