Job Details
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.