Medical Collections Representative

1 month ago

OceansideEscondido, United States VQ Orthocare Full time
Job DescriptionJob Description

This is an in-office full time position, please do not apply if your are only seeking a remote of hybrid role

Summary: The Medical Collections Representative is responsible for facilitating the collection of accounts receivable, applying payments to customer’s accounts, negotiating settlements, and maintaining accounts receivable records. The essential responsibilities are typically a variety of projects of significant scope and complexity. Work is subject to periodic review upon completion and is typically performed under general direction.

Essential Duties and Responsibilities:

  • Answer accounts receivable telephone inquiries and follow up.
  • Respond to mail correspondence, mail determinations, Explanation of Benefits, or requests for information from payors.
  • Call and/or mail correspondence to customers, as necessary, in order to update accounts.
  • Call and/or mail correspondence to payors regarding unpaid charges, including creating and mailing written appeals, rebuttals, and resubmissions to payors regarding unpaid charges.
  • Collect, verify, and record key information on accounts for billing and/or litigation purposes.
  • Maintain reporting on customer/patient accounts receipts/payment received from patients or payors.
  • Obtain and mail invoice copies for customers, as requested.
  • Prepare and review Patient Statements and submits for payment.
  • Research and process customer claims of invoice payment.
  • Research and process charge backs, returns, and bad checks.
  • Research customer credit, skip traces, locates assets, and ability to pay.
  • Regularly check on status of unresolved liens with attorney or payors.
  • Assist with other assignments or special projects, as required.
  • Review existing solutions to determine best methods for solving problems.
  • Assist with development of proactive problem solving methods as they relate to Insurance operations &/or Company processes
  • Make routine decisions requiring moderate use of independent judgment.
  • Troubleshoot and resolve problems through all departmental processes.
  • Assist with training/guidance of other non-exempt staff and team members
  • Identify concerns &/or recommendations for process improvement.
  • Analyze account information and determines appropriateness of continuing service on account.
  • Analyze payment record on accounts and determine timing of appeals, filing of liens and/or Declaration of Readiness to Proceed documents.

 

Competency:

  • Job Specific Duties: To appropriately and effectively support the function and activities of the Insurance Department
  • Decision-Making, Judgment, Problem Solving: To act on familiarity of advanced concepts, principles, procedures that apply to job assignments to achieve solutions.
  • Job Knowledge: To act on Familiarity of most relevant company policies and advanced concepts that apply to departmental policies, procedures & specific job tasks to complete a wide variety of routine & unique projects.
  • Project Management, Planning & Organization: To effectively plan and organize responsibilities to complete assignments within required parameters and pre-established time-management standards.

 

Communication & Ethics: To appropriately and ethically represent the company and initiate actions and/or communications which will best serve the interests of VQ OrthoCare

Qualifications:


• 2+years of commercial medical collections (HMO, PPO, Medicare is a plus). Back end collections not Front end experience
• Familiar with the overall denial and appeals process
• Must have knowledge understanding of Explanation of Benefits (EOB), ICD-10 and HCPC codes


Education and Experience:


• High School Diploma/GED
• 2+ years related experience or equivalent of education plus directly related education, training and experience
• Preferred experience includes collections experience in a medical device workplace environment.

Physical and Mental Demands:

  • Typically interacts with staff, peers, senior management and external customers
  • Ability to handle moderate to high stress
  • Regularly required to sit, stand, move about, stoop, bend, reach, finger and grasp and to move and/or lift up to 50 pounds
  • Regularly must see and read computer displays and reports, PDA displays & cell phone displays
  • Must regularly type and or enter data using computer keyboards.

Certificates and Licenses:

  • No special certificates, licenses or registrations are required

Supervisory Responsibilities:

The job has no supervisory responsibilities.

Work Environment:

Reasonable accommodations may be provided in order to allow qualified individuals with disabilities to perform the essential duties and tasks.

The work environment varies between that of a typical office setting with controlled temperature and humidity and a typical automobile interior, traffic and noise associated with commuting, along with typical patient home environments for short durations. Ambient noise levels are consistent and generally low to moderate.

 

**VQ OrthoCare is and Equal Opportunity Employer: All Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

***VQ OrthoCare is a participating E-Verify employer

Company DescriptionVQ Orthocare is a DME manufacturer and retailer recently celebrating our 25th yearCompany DescriptionVQ Orthocare is a DME manufacturer and retailer recently celebrating our 25th year

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