Collector - AVALA Hospital - RH360

Summary

Responsible for the collection processes on accounts related to all Medicare Medicare A Medicaid and other state and federal health care programs in order to expedite claim processing and reimbursement. Reviews denials and submits appeals following Medical LCDs and NCDs guidelines. Assist with support in other areas as needed.

Essential Duties and Responsibilities

• Performs follow ups on outstanding accounts and provides companies with any information that will allow them to expedite payment and processing of the claim. Documents all efforts into computer software.
• Consistently identifies and resolves billing discrepancies to ensure and expedite reimbursement; works closely with billing and keeps team appraised of issues and problems with billing processes and companies; works all denials and files appeals when necessary to protect reimbursement. Follows up until resolved.
• Works all insurance denials from assigned payers; document all denials and notifies Business Office Manager in a timely manner.
• Process patient and insurance refunds and attaches a copy explanation of benefits for reference.
• Review accounts and forwards qualified accounts to collections if needed.
• Assist collection agency with questions on placed accounts.
• Reviews patient statement listing each week to identify any accounts that require a statement hold and places hold when appropriate.
• Coordinates any accounts requiring a rebill with the biller.
• Answer patient inquires in a timely manner.
• Keeps updated on all contract terms and CMS regulations.
• Assist with billing questions as needed.

Core Competencies

Action Orientation - Targets and achieves results overcomes obstacles accepts responsibility establishes standards and responsibilities creates a results-oriented environment and follows through on actions.

Communications - Communicates well both verbally and in writing. Effectively conveys and shares information and ideas with others. Listens carefully and understands various viewpoints. Presents ideas clearly and concisely and understands relevant detail in presented information.

Creativity/Innovation - Generates novel ideas and develops or improves existing and new systems that challenge the status quo takes risks and encourages innovation.

Critical Judgment - Possesses the ability to define issues and focus on achieving workable solutions. Consistently does the right thing by performing with reliability.

Customer Orientation - Listens to customers builds customer confidence increases customer satisfaction ensures commitments are met sets appropriate customer expectations and responds to customer needs.

Interpersonal Skills - Effectively and productively engages with others and establishes trust credibility and confidence with others.

Leadership - Motivates empowers inspires collaborates with and encourages others. Builds consensus when appropriate. Focuses team members on common goals.

Teamwork - Knows when and how to attract develop reward and utilize teams to optimize results. Acts to build trust inspire enthusiasm encourage others and help resolve conflicts and develop consensus in creating high-performance teams.

Professional Requirements

• Meets dress code standards and adheres to policy.
• Completes annual education requirements.
• Maintains regulatory requirements.
• Maintains patient confidentiality at all times.
• Reports to work on time and as scheduled completes work within designated time.
• Wears identification while on duty uses computerized punch time system correctly.
• Completes in-services and returns in a timely fashion.
• Attends annual review and department in-services as scheduled.
• Attends staff meetings annually reads and returns all monthly staff meeting minutes.
• Represents the organization in a positive and professional manner.
• Actively participates in performance improvement and continuous quality improvement (CQI) activities.
• Complies with all organizational policies regarding ethical business practices.
• Communicates the mission ethics and goals of the hospital as well as the focus statement of the department.
• Assists other staff members in performing any duty that enhances the delivery of patient care

Regulatory Requirements

• High school diploma.
• Two years or more experience.

Skills

• Ability to communicate effectively in English both verbally and in writing.
• Basic computer knowledge.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job the employee is regularly required to talk and hear. This position is very active and requires repetitive motions standing walking bending kneeling and stooping all day. The employee must frequently lift or move items weighing up to 20 pounds.