Medical Coder

**Notes**:
100% onsite. Minimum of 50 claims per day doing insurance AR follow up -Certifications needed? High School Diploma and minimum of 3 years’ experience doing AR follow up

**Duties**:
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.
- 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 Bene?ts (EOBs) and Electronic Remittance Advices (ERAs) to ensure proper payment as well as assist and educate patients and colleagues with understanding of bene?t plans.
- Understanding of hospital billing form requirements (UB04) and familiar 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 e?ectively 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 me 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.
- Consistently meets individual productivity and quality assurance standards In addition to the above, the Collector II demonstrates pro?ciency in the functions mentioned above.
- Assists in multiples 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.

**Skills**:
Required Skills & Experience:

- Three years of experience in a hospital/medical and/or related ?eld or strong background in customer service.
- Working knowledge of Epic Resolute, Eric Care, and Epic CPOE.
- Intermediate Excel knowledge is a must.
- Diversity
- Technology & Equipment Skills
- Interpersonal Skills
- Job Knowledge
- Oral/Written Communication
- Travel
- Organization Behavioral Competencies
- BUSINESS ACUMEN
- CUSTOMER SATISFACTION
- INNOVATION
- TRUST & ACCOUNTABILITY
Preferred Skills & Experience:

- N/A

**Education**:
Required Education:

- High school diploma or equivalent required.
Preferred Education:

- N/A
Required Certifications & Licensure:

- N/A
Preferred Certifications & Licensure:

- N/A

Pay: $20.00 - $24.00 per hour

**Benefits**:

- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance

Schedule:

- 8 hour shift
- Day shift
- Monday to Friday

**Education**:

- High school or equivalent (required)

**Experience**:

- Accounts Receivable follow ups: 3 years (required)
- 50 claims per day doing insurance AR follow up: 3 years (required)
- Working w/ insurance companies, Govt. payors, &/or patients: 3 years (required)
- APC, DRG, APRDRG: 1 year (preferred)
- Revenue Cycle processes: 1 year (required)
- Knowledge of HMO, POS, PPO, EPO, IPA, Medicare Advantage: 1 year (required)
- knowledge of Epic Resolute, Eric Care, and Epic CPOE: 1 year (preferred)

Ability to Commute:

- Costa Mesa, CA 92626 (required)

Ability to Relocate:

- Costa Mesa, CA 92626: Relocate before starting work (required)

Work Location: In person