Medical Collector Specialist
5 days ago
Job Summary:
The Revenue Cycle Support Services Associate I coordinates and performs all collections follow-up on Medi-Cal/CCS denied authorizations and, if necessary, requests new and/or modified authorizations from both automated and manual payers in accordance with training materials, scripts, and standard operating procedures.
Key Responsibilities:
- Follows up on Medi-Cal/CCS denied authorizations and, if necessary, requests new and/or modified authorizations from both automated and manual payers.
- Reviews correspondence related to refunds or recoupments.
- Works with Finance and other Revenue Cycle Departments to optimize the cash posting, balancing, and reconciliation process.
- Responsible for evaluating credit balances and ensuring that refunds are issued to the appropriate payer in a timely and accurate manner.
- Ability to work on special projects as needed by management.
- Investigates unapplied cash receipts and resolves or escalates in a timely manner to lead or supervisor.
- Reverses balance to credit or debit if charges were improperly billed.
- Contacts insurance carriers as necessary to determine correct payment application.
- Communicates issues related to payment posting and refunds from payers to management.
- Updates correct payer information and resubmits claims to the appropriate payer(s).
- Consistently meets/exceeds productivity and quality standards.
- Performs other related duties as assigned by the management team.
Requirements:
- Minimum of three (3) years of healthcare experience in insurance verification, collections, cash posting, and refunds, with exposure to insurance verification, billing, or collections required.
- Knowledge of Medi-Cal, CCS-SAR payors, and authorization guidelines required.
- Familiarity with payer billing and reimbursement guidelines and regulations, including the ability to read and interpret payer Explanation of Benefits (EOB) and Remittance Advice Details (RAD).
- Proficient in all Microsoft Office software applications and EMR systems such as Athena.
- Ability to communicate effectively in both written and verbal formats with internal and external stakeholders.
- Ability to organize and manage time effectively.
- Handle all correspondence, documentation, and files in a professional and confidential manner, following HIP and PHI guidelines.
- Ability to be analytical, flexible, innovative, self-motivated, and work independently as well as part of a larger team.
- High School Diploma or equivalent required.
About Alura Workforce Solutions:
Alura Workforce Solutions is a leading provider of workforce solutions, dedicated to delivering exceptional results and exceeding client expectations.
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