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Sr. Medical Collector

companyGlobal IT Resources Inc.
locationCosta Mesa, CA, USA
PublishedPublished: 6/14/2022
Full Time

Job Description

Job Description

Position Summary:
-The Collector serves as the account representative for Hoag 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 Hoag.
-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 Admittance 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 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.

Skills:

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.

Preferred Skills & Experience:
-N/A

Education:

Required Education:
-High school diploma or equivalent required.

Preferred Education:
-N/A

Required Certifications & Licensure:
-N/A

Preferred Certifications & Licensure:
-N/A

Company DescriptionWe believe there is a fundamental need for independent financial advice across America and investors achieve better outcomes when working with a financial advisor. We provide resources, coaches, technology, access to subject matter experts and solutions to financial advisors nationwide.

Company Description

We believe there is a fundamental need for independent financial advice across America and investors achieve better outcomes when working with a financial advisor. We provide resources, coaches, technology, access to subject matter experts and solutions to financial advisors nationwide.

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