COLLECTOR I - Careers Integrated Resources : Job Details

Job title : Collector I

Location: Costa Mesa, CA

Job Duration: 6 Months (possible extension)

Pay Range: $27/h - $30/h on w2

Job Summary:

The Collector serves as the account representative for Client 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 Client.

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 Remittance Advices (ERAs) to ensure proper payment as well as assist 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 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 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 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 proficiency 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.