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Sr. Collections Representative

Finance | Emeryville, CA | Full Time, Contract, and Temporary

Job Description

Sr. Collections Representative 804109

Within the Government, Commercial, Contract and Managed Care (CCMC) Units, the Follow-Up Representatives are responsible for billing and follow-up of government, commercial, contract and/or managed care accounts receivables for MGBS clients. The incumbent demonstrates the ability to perform all aspect of billing and follow-up with quality. The incumbent’s main task is to resolve all outstanding insurance accounts through constant communication with the payers (by phone or via web access), other MGBS units, the company’s clinical departments, and billing agents.

Responsibilities:

  • Examines and evaluates accounts for appropriate follow-up action consistent with guidelines and documentation protocols prescribed in the SRG (Situation Response Guide).
  • Make daily inquiries on unresolved invoices by phone or via the internet.
  • Interpret account information and enter important details to provide an audit trail for further follow up. 
  • Research missing payments by reviewing EOB (Explanation of Benefits), APEX and RMS.
  • Review of non-payment and/or incorrect payment for possible appeal. This may include, but is not limited to the use of the following reference tools and guidelines:
    1. CCI edits
    2. Company Contract Report
    3. Profee Grid
    4. Medicare Fee Schedule
    5. Cascading guidelines
    6. CPT, ICD-9 or ICD-10, HCPC, Medical Terminology Manuals.
  • 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, and commercial insurance.
  • Initiate Charge Correction request.
  • Submit requests to department via RFI (Request for Information) process and review response for appropriate action.
  • Retrieve all required information needed in order to evaluate correct credit balance and/or correct refund payee.
  • Complete and submit refund request with detailed back-up to the unit manager for approval.
  • Effectively communicate with MGBS peers, payers, patients, company department Leads, Assistant Managers and managers.
  • Utilize knowledge of various systems including, but not limited to:
    1. 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.
    2. Other Follow Up Duties May include: 
    3. Secure guarantor/patient demographic and /or insurance information as required.
    4. Process correspondence as required in accordance with departmental procedures.
    5. Billing or rebilling corrected claims.
    6. Create Orthopedic DME (Durable Medical Equipment) Invoice form for DME billing attachment
    7. Notify manager of possible procedural change for improving efficiency.
    8. Perform other duties as assigned.
    9. Attend and be engaged in monthly CQI and KPI (monthly one on one) meeting and unit and team meetings aimed at increasing knowledge.  
Requirements:
  • This position requires flexibility to orient and work at all company locations.
  • At least 1 year of previous Insurance Follow up experience. 
  • Demonstrate the ability to communicate effectively (orally and written). 
  • Knowledge of CPT / ICD-9 or ICD-10
  • Experience With Denials Management
  • Experience with MS EXCEL and OUTLOOK. 
  • Effective Time Management and Ability to Meet Deadlines
  • Ability to work independently or as needed with a team. 
  • Ability to meet productivity and quality standards. 
  • Demonstrates positive attitude and excellent customer service skills. 
  • Proven ability to coach and mentor staff for optimal results
  • Ability to set priorities, goals, and objectives
  • Demonstrate the ability to perform all aspects of billing and follow-up with superior quality. 
  • Excellent Attendance Record. 

Preferred Qualifications:

  • Prior to working knowledge of the EPIC (Apex) system, especially PB or HB Insurance Follow up Module(s). 
  • Certified Procedural Coder (CPC)
  • High School Graduate or GED equivalency
  • Associates or Bachelor’s Degree 

$25 per hour              Emeryville, CA 94608            12 Month Assignment