Description
This position is to backfill for someone out on leave - may or may not return.
Job Title: COLLECTOR II
Education Requirement: High school diploma or GED
Qualifications:
Minimum two years collector, biller, or customer service representative experience (or combination of all three) in related health care patient accounting field within the last four years
Ability to demonstrate knowledge of the Fair Debt Collection Practices Act and NAIC Guidelines; local, state, and/or federal Commercial laws and regulations; billing requirements, to include, but not limited t ICD-9, CPT, and DRG codes, and fee schedule allowances and reductions; medical terminology and calculations necessary for account management
Ability to demonstrate knowledge of line of business specific billing and collection rules, regulations and other pertinent payer specific requirements
Demonstrated ability to work with patient accounting and computerized collection systems and use Windows operating system and Microsoft Office Applications (WORD, EXCEL, etc.)
Demonstrated ability to utilize and apply active listening, communication, and persuasion skills, as well as the principles and processes needed to provide customer service
Type 45 WPM
Ability to read, write and perform basic mathematical computations at a high school level
Ability to work well in a team environment and within the Labor Management Partnership guidelines and effectively participate in Unit Based Teams
Ability to lift 20 pounds
Ability to sit for long periods of time
Ability to use general office equipment including telephones, fax, copier, etc
Preferred Experience:
AA degree in Business or certification in insurance billing or collections issued by an accredited learning institution
Multi-lingual
Position Summary:
Within Regional and Departmental Policies & Procedures and under direct supervision, this position is responsible for the collection of delinquent billed accounts and resolving outstanding receivables by performing collection and claim status follow-up activities, settlement negotiations, processing appeals, identifying and processing adjustments and other write-offs, and agency assignments for qualified accounts by processing and notating accounts in the host system.
Representative Duties:
Determine appropriate collection action by processing accounts in assigned work queues (eg, Work Queues, collector assignment report, aging reports, etc.).
Responsible for follow-up and collection of accounts, including, but not limited t inpatient, outpatient, emergency room, and pharmacy charges for all in- and out-of-network services, etc. by various means (systems, reports, etc.).
Make recommendations as well as make decisions to refer accounts to appropriate line of business for billing/rebilling and/or outside collection agencies at any stage of the internal collection process.
Review accounts to ensure compliance with applicable local, state, and/or federal law and regulations, including organization policies and procedures.
Correspond with interested parties to resolve receivables via in-coming and out-going telephone, fax, mail, e-mail, telegram, and/or legal correspondence for accounts.
Update accounts receivable systems and department databases that maintain detailed insurance and claim information for collection of accounts with appropriate account notes regarding follow-up activities and any appropriate account revisions.
Effectively collect balances due with any applicable penalties and interest on assigned accounts.
Responsible for gathering information, making recommendations related to adjustments of uncollectible balances and completing accounts appropriately.
Identify accounts which require refunds, calculate refund amounts, and refer accounts to appropriate support staff
Respond to in-coming correspondence and telephone inquiries from patients, guarantors, third parties, attorneys, and other facilities or departments, etc. regarding accounts
Make referrals to appropriate departments to resolve any initial and supplemental billing issues
When necessary, work with staff of various business offices, insurance carriers, Call Center, member service departments, provider areas and California Service Center (CSC) to facilitate corrections or other required revisions necessary to collect assigned accounts.
Responsible for initiating out-bound collection calls and handling in-bound call volumes within the standard(s) established by the department
Achieve individual production and quality assurance performance within established expectations and standards.
Comply with legal and ethical requirements to protect patient, employee, and Client's confidentiality.
Identify and communicate ways of improving department processes, procedures and customer relations by participating in Unit Based Teams and other Labor Management Partnership processes.
Interpret benefits, exclusions and accurate reimbursement levels of primary and secondary insurance coverage.
Review and interpret Explanation of Benefits (EOB) to ensure all revenue-generating possibilities have been exhausted and take appropriate action, including but not limited t posting adjustments, posting denials, processing appeals, changing financial classes, processing adjustments and write-offs, rebilling/secondary billing, etc.
Responsible for electronic billing/paper billing and interface between client billing facilities and external entities.
Utilize documentation (eg, settlement draft, settlement release, awards issued by the court) to ensure maximum case settlement and take appropriate action for the following: posting adjustments, posting denials, processing appeals, changing financial classes, processing revenue reversals, write-off, rebilling/secondary billing, etc.
Assist with preparation of cases for litigation by collecting supporting documentation.
Verification of pertinent account data (ie, coverage, benefits, eligibility, authorization, etc.)that is required to facilitate collection activities and/or write-off recommendations.
Perform other duties as assigned, including but not limited to, special projects.