Description
Insurance Collector
Description:
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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.
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Would be performing collection with Self-Funded TPA & following up on denials for DHMO, HMO, ACA & KP Medicare products.
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Determine appropriate collection action by processing accounts in assigned work queues (egWork Queues, collector assignment report, aging reports, etc.).
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Responsible for follow-up & collection of accounts, including, but not limited to: inpatient, outpatient, emergency room, & pharmacy charges for all in-&out-of-network services, etc. by various means (systems, reports, etc.).
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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.
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Review accounts to ensure compliance w/applicable local, state, and/or federal law & regulations, including organization policies & procedures.
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Correspond w/interested parties to resolve receivables via in-coming & out-going telephone, fax, mail, e-mail, telegram, and/or legal correspondence for accounts.
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Update accounts receivable systems & department databases that maintain detailed insurance & claim information for collection of accounts w/appropriate account notes regarding follow-up activities & any appropriate account revisions.
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Effectively collect balances due with any applicable penalties and interest on assigned accounts.
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Identify accounts which require refunds, calculate refund amounts, & refer accounts to appropriate support staff.
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Respond to in-coming correspondence & telephone inquiries from patients, guarantors, third parties, attorneys, & other facilities or departments, etc. regarding accounts.
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Make referrals to appropriate departments to resolve any initial &supplemental billing issues.
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When necessary, work w/staff of various business offices, insurance carriers, Corona Call Center, member service departments, provider areas &California Service Center (CSC) to facilitate corrections or other required revisions necessary to collect assigned accounts.
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Responsible for initiating out-bound collection calls &handling in-bound call volumes w/in the standard(s) established by the department.
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Achieve individual production & quality assurance performance w/in established expectations & standards.
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Comply w/legal & ethical requirements to protect patient, employee, and organization's confidentiality.
Requirements:
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Customer focused well versed in health care collection activities
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Understanding of health care billing guidelines and terminology
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1-5 years of experience researching and validating commercial primary insurance, health care billing and collections are required.
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Demonstrated expertise in applicable subject matter, based on assigned production area, is required.
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Experience in Microsoft NT, Word, Excel, and Access is required.
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One year of experience in customer service is preferred.
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HS/GED required, Associates or Bachelors degree preferred.
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Knowledge of SMS, HSD Diamond, and TPL module is preferred.
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Minimum of 2 years experience within the last 4 years in collections environment.
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Must have experience in healthcare/medical environment.
Parking is not covered, and is generally $7-$8 daily.