Medical Collector

Pride Health is hiring a Collector for one of its clients in California.

This is a 3-month contract with a possible extension with competitive pay and benefits.

Location Costa Mesa, California 92626

Pay range - $24 - $28 per hour.

Length of assignment 3 months (With Possible extension)

Shift Monday-Friday 1st shift.

Job Summary

The Collector serves as the account representative for the Client in working with insurance companies, government payors, and/or patients for the resolution of payments and accounts resolution.

Job Duties

• 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 Client.
• Reviews and completes payor and/or patient correspondence promptly.
• 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 the 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, and understanding of terms and conditions, as well as Federal and State requirements.
• Interprets Explanation of Bene ts (EOBs) and Electronic Remittance Advices (ERAs) to ensure proper payment as well as assist and educate patients and colleagues with understanding of bene t plans.
• Understanding of hospital billing form requirements (UB04) and familiarity 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 e ectively 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 me payment is due.
• May review for applicable cash rates, special rates, and applicable professional and employee discounts.
• May process bankruptcy and deceased patient accounts.
• Performs other duties as assigned.
• Consistently meets individual productivity and quality assurance standards In addition to the above, the Collector II demonstrates pro ciency in the functions mentioned above.
• Assists in multiple areas, payors, or departments.
• Assist with special projects and/or additional tasks as needed.
• Able to problem-solve issues as they arise and independently research as needed for resolution.
• Provide support and assist with training of peers as needed.
• Exceeds individual productivity and quality assurance standards for at least 6 consecutive months.
• No corrective action within the last 6 months.

Requirements

• High school diploma or equivalent required.
• Minimum of 50 claims per day doing insurance AR follow-up.
• Minimum of 3 years experience doing AR follow-up.
• Three years of experience in a hospital/medical and/or related eld or strong background in customer service.
• Working knowledge of Epic Resolute, Eric Care, and Epic CPOE.
• Intermediate Excel knowledge is a must.
• Diversity
• Technology & Equipment Skills
• Interpersonal Skills
• Job Knowledge
• Oral/Written Communication
• Travel
• Organizational behavioral Competencies

Pride Global offers eligible employee s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, , legal support, auto ,home insurance, pet insurance, and employee discounts with preferred vendors.