Medical Collections

California  ‐ Onsite
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Keywords

Description

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 acconts by processing and notating accounts in the host system.

TOP SKILLS

1. Knows how to collect payment from Medi Cal for hospital bills
2. Understands Medi Cal billing requirements
3. Has billing experience within a hospital setting

TOP  RESPONSIBILITIES

1. works assigned AR Reports of unpaid Medi Cal accounts to collect on
2. Worksy system generated work lists of paid Medi Cal account for reconciliation in order to identify possible underpayment or overpayment
3. Makes outgoing collection phone calls
4. Responds to incoming correspondence from Medi Cal and other medical insurance carriers
5. Processes appeals on denied claims

POSSIBILITY OF EXTENDING TO 6 months

Job description:

1. Determine appropriate collection action by processing accounts in assigned work queues (Work Queues, collector assignment report, aging reports, etc.).
2. 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.).
3. 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.
4. Review accounts to ensure compliance with applicable local, state, and/or federal law and regulations, including organization policies and procedures.
5. 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.
6. 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.
7. Effectively collect balances due with any applicable penalties and interest on assigned accounts.
8. Responsible for gathering information, making recommendations related to adjustments of uncollectible balances and completing accounts appropriately.
9. Identify accounts which require refunds, calculate refund amounts, and refer accounts to appropriate support staff
10. Respond to in-coming correspondence and telephone inquiries from patients, guarantors, third parties, attorneys, and other KP facilities or departments, etc. regarding accounts
11. Make referrals to appropriate departments to resolve any initial and supplemental billing issues
12. When necessary, work with staff of various business offices, insurance carriers, Corona Call Center, member service departments, provider areas and California Service Center (CSC) to facilitate corrections or other required revisions necessary to collect assigned accounts.
13. Responsible for initiating out-bound collection calls and handling in-bound call volumes within the standard(s) established by the department
14. Achieve individual production and quality assurance performance within established expectations and standards.
15. Comply with legal and ethical requirements to protect patient, employee, and client confidentiality.
16. Identify and communicate ways of improving department processes, procedures and customer relations by participating in Unit Based Teams and other Labor Management Partnership processes.
17. Interpret benefits, exclusions and accurate reimbursement levels of primary and secondary insurance coverage.
18. 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.
19. Responsible for electronic billing/paper billing and interface between KP billing facilities and external entities.
20. 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.
21. Assist with preparation of cases for litigation by collecting supporting documentation.
22. Verification of pertinent account data (ie, coverage, benefits, eligibility, authorization, etc.)that is required to facilitate collection activities and/or write-off recommendations.

QUALIFICATIONS

1. 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 OR one year collector experience combined with a Line of Business Training Certificate
2. 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
3. Ability to demonstrate knowledge of line of business specific billing and collection rules, regulations and other pertinent payer specific requirements
4. Demonstrated ability to work with patient accounting and computerized collection systems and use Windows operating system and Microsoft Office Applications (WORD, EXCEL, etc.)
5. Demonstrated ability to utilize and apply active listening, communication, and persuasion skills, as well as the principles and processes needed to provide customer service
6. Type 45 WPM
7. Ability to read, write and perform basic mathematical computations at a high school level
8. Ability to work well in a team environment and within the Labor Management Partnership guidelines and effectively participate in Unit Based Teams
9. Ability to lift 20 pounds

PREFERRED:

1. AA degree in Business or certification in insurance billing or collections issued by an accredited learning institution
2. Multi-lingual

Start date
n.a
Duration
10 weeks +
(extension possible)
From
Enclipse Corp.
Published at
27.09.2012
Project ID:
426459
Contract type
Freelance
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