Collections Representative (L)
Collections | Emeryville, CA | Full Time, Contract, and Temporary
Collections Representative 823823 (L)
- Corrections of Accounts in Retro-Adjudication WQ and PB Charge Review WQ
- Examines and evaluates accounts for appropriate registration and coverage.
- Verification of erred RTE responses in PB Charge Review
- Assign visits with the correct primary coverage and update unposted charges
- Timely filing of PB Charge Review charge sessions in keeping with company lag day goals
- Correction of registration errors made by frontend and backend staff
- Clarification of primary coverage - working with the regulations of Medicare and Medi-Cal as well as contractual DOFR set-up
- Review of entire AR of account to assure that all billing has been made to the correct payor in the correct order
- Interpret account information and enter important details to provide an audit trail for follow up and patient
- Research payments received in regards EOB (Explanation of Benefits), APEX and Health Logic to confirm correct primary payment.
- Review of non-payment and/or incorrect payment for possible registration and coverage. This may include, but is not limited to the use of the following reference tools and guidelines:
- RTE response
- Payor Website
- EOB Information
- APeX Follow-up Notes and SBO Notes
- CMS Coverage Guidelines
- Medi-Cal Eligibility Tool
- Analyze Explanation of Benefits (EOBs) for accurate posting of rejection, adjustment and other posting requirements needed in APEX.
- Adheres to the rules and regulations of the different types of payers such as Medicare, Medi-Cal, CCS, PPO, EPO, HMO, Covered CA and commercial insurance.
- Perform Charge Corrections when cleaning-up charges billed in error.
- Balancing of payments of paid services not posted correctly
- Retrieve all required information needed in order to evaluate correct credit balance and/or correct refund payee.
- Effectively communicate with MGBS peers, payers, patients, company departments Leads, Assistant Managers and managers.
- Utilize knowledge of various systems including but not limited to:
- Microsoft Word, EXCEL, Outlook, APEX, Payor Web Portals, Health Logic, government and/or non-government websites, and any other information systems which would be required for insurance eligibility, benefit verification or other information needed during detailed follow-up.
- Other Retro-Adjudication Duties May include:
- Secure guarantor/patient demographic and/or insurance information as required
- Process correspondence as required in accordance with departmental procedures
- Billing or rebilling corrected claims
- Notify manager of possible procedural change for improving efficiency
- Perform special projects or other duties as assigned by the manager
- Attend monthly meetings and unit and team meetings aimed at increasing knowledge
- At least 2 years of previous insurance billing experience
- Demonstrate the ability to communicate effectively (orally and written)
- Experience with MS Excel and Outlook
- Ability to work independently or as needed with a team
- Proven ability to coach and mentor staff for optimal results
- Demonstrate the ability to perform all aspects of Retro Review with superior quality
- Problem solving
$26 per hour Emeryville, CA 94608 10 Month Assignment