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Government Collector/Appeals Specialist

2 months ago

Alhambra, California, United States Keck Medicine of USC Full time
Job Summary

Keck Medicine of USC is seeking a highly skilled Government Collector/Appeals Specialist to join our team. As a key member of our revenue cycle department, you will be responsible for managing patient accounts from discharge through billing edits to contract management, ensuring timely and accurate collection of expected contract amounts.

Key Responsibilities
  • Manage patient accounts from discharge through billing edits to contract management, ensuring timely and accurate collection of expected contract amounts.
  • Develop and maintain in-depth technical knowledge of billing and collections guidelines for Medicare, Medi-Cal, and local Medi-Cal entities.
  • Stay up-to-date on billing changes and requirements to ensure prompt, defect-free claims for timely payment and minimize denials.
  • Perform all necessary functions to submit claims for payment, work independently on inventory for account follow-up, appeals, and identify accounts that need escalation.
  • Identify opportunities for improvement and develop effective solutions to enhance the revenue cycle process.
  • Actively contact payers by phone, mail, or websites to identify barriers impacting payment of claims and work independently to address these barriers.
  • Handle customer calls and payer inquiries accurately regarding charge inquiries, account status, and other related matters.
  • Process correspondence within the established timeline of 5 days from receipt and work EOBs and remits within two work days.
  • Resolve credit balance accounts in a timely manner and resolve underpayment or denial with appropriate action to ensure all accounts are paid per contracted rate.
  • Knowledge of all contract payers, rates, and agreements, and ensure accurate insurance coding is utilized.
  • Properly evaluate reimbursement amounts to ensure maximum payment is being received for all services provided and appeal underpayments when necessary.
  • Place calls to health plans or look up patient eligibility information on insurance contracts websites to obtain patient eligibility information, update insurance, and/or forward claims to medical groups to update.
  • Have a clear understanding of the payer matrix of financial responsibility and utilize this knowledge to do appropriate follow-up on accounts.
  • Enter appropriate documentation online to records activity on patient accounts, including expected reimbursement amounts when calculated manually.
  • Use initiative to resolve problems with appropriate action and follow-through, including documentation when involved in patient/department issues.
  • Identify existing problems in the workflow and utilize resources available to maintain a productive workflow.
  • Accommodate to changes in workload within the department by assisting others and keep supervisor informed when problems may interfere with work being completed on time.
  • Adapt to changes of unusual circumstances, promote cooperation, and minimize disruption to the working environment.
  • Participate in review, revising, and developing policies and procedures for the department.
Requirements
  • High school or equivalent
  • Bachelor's degree in a related field or equivalent in years of service within the scope of AR Management
  • 3 years of acute care hospital collections and follow-up experience
  • Working knowledge of governmental regulations and requirements
  • Excellent written skills for appeals purposes
  • Knowledge of medical terminology and coding
  • Demonstrate excellent customer service behavior
  • Demonstrate excellent verbal and written communication skills
Preferred Qualifications
  • Fire Life Safety Training (LA City) if no card upon hire, one must be obtained within days of hire and maintained by renewal before expiration date (Required within LA City only)