Collector

Job Title: Collector
Duration: 6 months
Location: Costa Mesa CA 92626

Note: EPIC Hyperspace is preferred but not required. 100% onsite. Candidates are expected to work 50 accounts per day after the 60 day training period.

Position Summary:

• The Collector serves as the account representative working with insurance companiesgovernment 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.
• 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 Benefits (EOBs) and Electronic Admitt ance Advices (ERAs) to ensure proper payment as well asassist and educate patients and colleagues with understanding of benefit plans.
• Understanding of hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms.
• Knowledge ofHMO POS PPO EPO IPA Medicare Advantage Covered California (Exchange) capitationcommercial and government payors (i.e. Medicare Medi-Cal TriCare etc) and how these payors process claims.
• Demonstrates knowledge of and effectively 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 time 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

Required Skills & Experience:

• One year of previous hospital business experience or equivalent required or strong background in customer service.
• Basic experience with insurance plans hospital reimbursement methodology and/or ICD10 and CPT coding.