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Sr. Collections Representative 563876

Finance | Emeryville, CA | Full Time and Contract

Job Description

Sr. Collections Representative

Follow-up Collector is responsible for collections, conducting proactive follow up with payers and patients regarding non-payments, underpayments, or incorrect payments in a stratified manner. Collector calculates expected reimbursement, recommends accounts for collection agencies or legal assignment. Collector negotiates prompt payment discounts and sets up payment plans according to departmental guidelines. Collector reconciles the accounts to closure. Collector is knowledgeable of the medical center’s discount and charity policy. 

Responsibilities:

  • Commercial, Contracts, and Managed Care Specific Requirements
  • Analyze and interpret the various managed care contracts to ensure compliance with the terms and conditions of the contract. 
  • Ensure appropriate Worker’s Compensation specific billing codes are used where applicable. 
  • Ensure appropriate authorizations, pre-certifications are on file and appropriately documented on the UB04 and/or on-line systems as required. 
  • Thorough understanding of all UB04 field requirements. 
  • Ensure correct payer codes and billing addresses are used in accordance with company’s managed care contracts, Worker’s Compensation carrier, indemnity insurance company, or other third party.  
  • Commercial Managed Care Transplant Billing and Collections
  • To administer all non-governmental commercial insurance contracts according to specific contract guidelines, which can include the global billing of professional fee claims and outside services provided to transplant patients. 
  • Ensure appropriate procedures are following and account data is updated and reported at all times in the PFS Transplant Database Application to ensure accurate reporting of all transplant data. 
  • Processing of package billing in accordance with contract requirements and ensuring that all payments are reviewed and analyzed to facilitate payment to professional fee billing groups. 
  • Thorough and complete use of EPIC/APEX workqueues and activity codes to ensure accounts are appropriated and identified by current status in A/R. 
  • Analyze and prepare adjustments to A/R when appropriate and applicable to claim follow up at all stages of billing (i.e. interim and final billing for post payment review). 
  • Secure all forms and pertinent information for billing (i.e., medical records reports, DOFRs, EOBs, R/A’s, COB information, departmental reports, authorizations, precertifications, TARs, MSP forms, UPIN/PIN #’s, physician license #’s, consents, and other information as required). 
  • Review all bills and accounts for accuracy, completeness, and compliance with all local, state, and federal requirements (i.e., diagnosis codes, procedure codes, UB codes, UB04 claim completion, charges, billing information, etc.). 
  • Sort hardcopy bills stratified by dollar amount. 
  • Submit bills to payers in a timely and stratified manner in accordance with department and payer requirements. 
  • Enter detailed account notes in EMR system on-line notes as to where, when and dollar amount billed providing an audit trail for future follow up. 
  • Complete billing WIP and Follow-up WIP, activity reports and worklists and batch QUIC logs as required. 
  • Work error reports and transmit corrections on electronically submitted claims as required.
  • Bill secondary insurance as required. 
  • Check on-line contract information as required. 
  • File appeals and contact the managed care department as required. 
  • Secure guarantor/patient demographic and/or insurance information as required.  Update EPIC/APEX sections with accurate and complete information. 
  • Inform appropriate parties according to established guidelines of CPT4/HCPCS coding problems, incorrect UB codes, incorrect insurance plan codes, addresses, and compliance issues as required. 
  • Check on-line systems for eligibility and/or benefit verification (i.e. DDE, CERTS, POS, Share of Cost, etc.) including claim status from payer websites. 
  • Maintains a thorough working knowledge of billing procedures per established office policies, county, state and federal regulations. 
  • Enter accounts with deficiencies on the appropriate QUIC lists for accountability and management.  Maintains current status by updating, deleting, adding and tracing aged accounts with responsible entities.                                          
  • Conducts proactive follow up with payers regarding non-payments, underpayments, or incorrect payments in a stratified and timely manner. Files appeals meeting payer format and timely appeal requirements. 
  • Processes all payer denials, inquiries and correspondence in a timely and stratified manner.
  • Monitors current status of billing and collections in a stratified manner via RFI workqueues by directing appropriate questions to responsible departments or agencies. 
  • Add/update insurance information, payer information and financial class information as needed. 
  • Prepare accounts for transfer to collection agencies, attorneys and other agencies as per established department/hospital guidelines. 
  • Maintains current status of accounts by processing late charges, credits, corrected billings, write offs, refunds, contractual adjustments or charity determinations as required. 
  • Receives and resolves to completion, incoming calls from patients, insurance companies, M-Cal Field Office, CCS, other third party payers, hospital departments, and external entities as required. 
  • Calculate expected reimbursement. 
  • Analyze accounts for discounts or charity adjustment in accordance with established policies. 
  • Ensure reimbursement is accurate and appropriate contractual allowances have been applied.
  • Elevate problem accounts to a supervisor in a timely manner.  

Requirements: 

  • Minimum of one to three years’ experience in a hospital billing office environment.
  • High school graduates or GED certificate.
  • Must demonstrate an in-depth understanding of all aspects of billing greater than an Office Assistant II and Office Assistant III.
  • Knowledge of contracts, insurance billing requirements, UB92 claim forms, Worker’s Compensation, HMOs, PPOs, capitation, Medicare, Medi-Cal and compliance program regulations.
  • Good analytical and organizational skills, interpersonal, verbal, and written communication skills.
  • Knowledge of computer operation, keyboard functions, calculator, copier and fax machine operation.
  • Adequate keyboard skills.
  • Knowledge of electronic billing systems (i.e. NEIC, Cirius, WebMD, Envoy, etc.).
  • Proactive and assertive account resolution skills.
  • Must be a motivated individual with a positive and exceptional work ethics.
  • Ability to follow directions and written procedures.
  • Ability to balance assertiveness with compassion for the patient and others.
  • Must have a thorough understanding of CPT, ICD, DRG, and HCPC codes.
  • Must have a thorough understanding of stop losses, per diems, carve outs and other contract terms and conditions.
  • Computer software skills (i.e. Microsoft Applications and E-mail, etc.)

Preferred:

  • Medical terminology experience.
  • ICD9, CPT4, HCPCS, DRG coding experience.
  • Understanding of HIPAA rules and regulations.

$25 Per Hour          Emeryville, CA 94608             3-6 month contract