Collector II

1 month ago

Costa Mesa, United States DB HEALTHCARE INC Full time
Job DescriptionJob Description

Title: Collector II - CA
Location: Costa Mesa, CA 92626
Type: Contract
Duration: 3 Months
Start Date: 05/27/2024
Positions: 1
Role Type: Local candidates only

Job Summary:
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.

Responsibilities:

  • 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 the direct supervisor for review and resolution. 
  • Interprets Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs) to ensure proper payment as well as assist and educate patients and colleagues with an understanding of benefit plans. 
  • 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, and applicable professional and employee discounts. 
  • May process bankruptcy and deceased patient accounts. 
  • Performs other duties as assigned. 
  • Consistently meets individual productivity and quality assurance standards In addition to the above, the Collector II demonstrates proficiency in the functions mentioned above. 
  • Assists in multiple areas, payors, or departments. 
  • Assist with special projects and/or additional tasks as needed. 
  • Able to problem solve issues as they arise and independently research as needed for resolution. 
  • Provides support and assists with training of peers as needed. 
  • Exceeds individual productivity and quality assurance standards for at least 6 consecutive months. 
  • No corrective action within the last 6 months. 

Required Skills:

  • Minimum of 3 years’ experience doing AR follow up
  • 3 years of experience in a hospital/medical and/or related field
  • Strong understanding of the Revenue Cycle processes, from Patient Access (authorizations & admissions) through Patient Financial Services (billing & collections), including procedures and policies. 
  • Thorough knowledge of managed care contracts, current payor rates, understanding of terms and conditions, as well as Federal and State requirements. 
  • Understanding of hospital billing form requirements (UB04) and familiarity with the HCFA 1500 forms. 
  • Knowledge of HMO, 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. 
  • Strong background in customer service

Education:

  • High school diploma or equivalent required

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