Medical Collector

Job Title - Collector Location-Costa Mesa, CA 92626 Duration- 6 months Possible extension Shift-Day 5x8-Hour Pay Range- $28/hr-$30/hr Job Duties The Collector serves as the client's account representative, working with insurance companies, government payors, and/or patients to resolve payments and accounts. 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 the 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 (authorization 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, and federal and state requirements. Interprets Explanation of Benefits (EOBs) and Electronic Admit ance Advice (ERAs) to ensure proper payment as well as assist and educate patients and colleagues with understanding of benefit 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 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, and applicable professional and employee discounts. May process bankruptcy and deceased patient accounts. Performs other duties as assigned. Skills: One year of previous hospital business experience, or equivalent required, or a strong background in customer service. Basic experience with insurance plans, hospital reimbursement methodology, and/or ICD10 and CPT coding. EPIC Experience is HIGHLY preferred. Education: High school diploma or equivalent required.