Government and Non-Government Collector - Patient Accounting

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Date: May 28, 2019

Location: Costa Mesa, CA, US

Company: Hoag Memorial Hospital Presbyterian

Job Description:

Job Summary:


The Govt & Non-Government Collector is responsible for the management of patient accounts from the point of admission to reimbursement from the payor. Works directly with patients, internal departments, external business partners (IPA’s, provider relations, government payors and insurance companies) and clinical departments for delivery of service to include but not limited to: Obtains the maximum reimbursement for hospital services, effectively maintains a professional and ethical relationship with all clients, payors and staff. Has expert knowledge of payor contracts, CPT/HCPCS and ICD-10 codes, medical policies, LCD’s and medical terminology. Works efficiently to ensure accounts are worked thoroughly and within a timely manner. Thrives within a team atmosphere, has strong customer service expertise, has a strong ability to multitask and has proficient computer skills.


Essential Functions:


  • Serve as the account representative for Hoag in working with insurance companies and/or government payors for resolution of payments.
  • Completes daily assigned accounts on the collection work-list.
  • 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 Hoag.
  • Conducts an audit of accounts for billing and regulatory requirements.
  • Help identifies charge capture and missing charge.
  • Recommends denial edits to help mitigate denials issues.
  •  Reviews and completes payor correspondence in a timely manner.
  • Escalates to the payor accounts that need to be appealed due to improper billing, coding and/or underpayments. 
  • Reports new/unknown billing edits to 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, understanding of terms and conditions, as well as Federal and State requirements.
  • Interprets Explanation of Benefits (EOBs) and Electronic Admittance Advices (ERAs) to insure proper payment as well as assist and educate patients and colleagues with understanding of benefit plans.
  • Understanding of hospital billing form requirements (UB04) and familiar 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)and how these payors process claims.
  • Demonstrates knowledge of and effectively uses patient accounting systems.
  • Performs other duties as assigned.


Education, Training and Experience Required:


  • High school diploma or equivalent with 2-3 years of billing and/or collection experience.


Preferred education, training and experience:


  • Collector: Basic understanding of ICD10, CPT coding and medical terminology.


Skills or Other Qualifications Required:


  • Analytical, critical thinking and sound decision-making skills.
  • Basic skills in Microsoft Office (Word/Excel).
  • Ability to communicate in a clear and professional manner.
  • Strong interpersonal skills.
  • Ability to problem solve, prioritize and follow-through completely with assigned tasks.

Nearest Major Market: Orange County
Nearest Secondary Market: Los Angeles

Job Segment: Medical, Accounting, Law, Medicare, Collections, Healthcare, Finance, Legal

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