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Non-Government Collector
3 months ago
Manage patient accounts from the point of discharge through billing edits to contract management account net down to final collection of the expected contract amount. Possess and maintain governmental payer knowledgeable of all billing standards and collection requirements. Acts as a collector and perform necessary follow-up to obtain the appropriately owed reimbursement for hospital services. Responsible for all accounts with a contracted insurance as the primary or current payer. Collector will using work lists follow-up with governmental payers to liquidate inventory submitted
Essential Duties:
- Technical knowledge of billing and collections for Medicare, Medi-Cal, local Medi-Cal entities. Continually keeping abreast of changes that impact billing and collections.
- Working knowledge of TARS and SARs processes and follow-up.
- Perform all necessary functions to appropriately billing perform account follow-ups, appeals to liquidate accounts payable.
- Identify opportunities for improvement and, when appropriate, develop and implement effective solutions.
- Actively contacts payers by phone or by mail when payment is delayed or is an underpaid amount.
- Handles all customer calls and payer inquiries accurately regarding charge inquiries, account status, etc.
- Processes correspondence within the established timeline of 5 days from receipt
- Resolves credit balance accounts in a timely manner. Resolves any underpayment or denial with appropriate action to ensure all accounts are paid per contracted rate.
- Knowledge of all contract payers, rates and agreements. Ensures accurate insurance coding is utilized.
- Properly evaluates reimbursement amounts to ensure maximum payment is being received for all services provided. Appeals when underpayments are received.
- Places calls to health plan or looks on insurance contracts website to obtain patient eligibility information, updates insurance and/or forwards claim to medical group to update.
- Has a clear understanding of the payer matrix of financial responsibility and utilizes this knowledge to do appropriate follow-up on accounts.
- Enters appropriate documentation online to records activity on patient accounts including expected reimbursement amounts when calculated manually.
- Uses initiative to resolve problems with appropriate action and follow-through, including documentation when involved in patient/department issues.
- Identifies existing problems in the workflow and utilizes resources available to maintain a productive workflow.
- Accommodates to changes in workload within the department by assisting others.
- Keeps supervisor informed when problems may interfere with work being completed on time.
- Adapts to changes of unusual circumstances, promotes cooperation and minimizes disruption to working environment.
- Participates in review, revising and developing policies and procedures for the department.
- Perform other duties as assigned.
Required Qualifications:
- Req Previous collection experience.
- Req Working knowledge of laws governing collections efforts, insurance and medical terminology, and reimbursement procedures.
- Req Medical services collections and computerized billing systems such as IDX.
Preferred Qualifications:
- Pref High school or equivalent
Required Licenses/Certifications:
- Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)
