Medical Collector

-The Collector serves as the account representative for 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.
-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 Admitt ance Advices (ERAs) to ensure proper payment as well asassist 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.

Job Types: Full-time, Contract

Pay: $23.00 - $25.00 per hour

Expected hours: 40 per week

Education:

• High school or equivalent (Required)

Experience:

• Medical Collection: 3 years (Required)
• insurance plans: 1 year (Required)
• hospital reimbursement: 1 year (Required)
• ICD-10 & CPT coding: 1 year (Required)
• Epic: 1 year (Required)

Ability to Commute:

• Costa Mesa, CA 92626 (Required)

Work Location: In person

Salary : $23 - $25