Collector II: Revenue Cycle Epic

Hoag•Costa Mesa, CA

6d•$24 - $37

About The Position

The Collector serves as the account representative for Hoag in working with insurance companies, government payors, and/or patients for resolution of payments and accounts resolution. This role involves completing assigned accounts within assigned work queues, obtaining maximum reimbursement by evaluating claims at the contract rate using the contract management tool for proper pricing (Examples: APC, DRG, APRDRG). The Collector will review and initiate initial appeals for underpayments, observe all timely requirements to secure reimbursement due to Hoag, and review and complete payor and/or patient correspondence in a timely manner. Escalation of accounts needing appeal due to improper billing, coding, and/or underpayments is also a key responsibility. The Collector will report new/unknown billing edits to the direct supervisor for review and resolution. A strong understanding of the Revenue Cycle processes, from Patient Access (authorizations & admissions) through Patient Financial Services (billing & collections), including procedures and policies, is essential. Thorough knowledge of managed care contracts, current payor rates, understanding of terms and conditions, as well as Federal and State requirements is required. The role involves interpreting Explanation of Benefits (EOBs) and Electronic Admittance Advices (ERAs) to ensure proper payment, as well as assisting and educating patients and colleagues with understanding of benefit plans. Familiarity with hospital billing form requirements (UB04) and HCFA 1500 forms is necessary. Knowledge of various payor types (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 is crucial. The Collector will demonstrate knowledge of and effectively use patient accounting systems, document all calls and actions taken in the appropriate systems, and accurately code insurance plan codes. Establishing payment arrangements for patients unable to pay in full is part of the role, and may involve reviewing for applicable cash rates, special rates, applicable professional and employee discounts, and processing bankruptcy and deceased patient accounts. The Collector II demonstrates proficiency in the functions mentioned above, assists in multiple areas, payors or departments, and aids with special projects and/or additional tasks as needed. They are expected to problem-solve issues as they arise and independently research for resolution, provide support and assist with training of peers, and exceed individual productivity and quality assurance standards for at least 6 consecutive months with no corrective action within the last 6 months.

Requirements

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.
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, TriCare, etc) and how these payors process claims.
Demonstrates knowledge of and effectively uses patient accounting systems.

Nice To Haves

Demonstrates proficiency in the functions mentioned above.
Exceeds individual productivity and quality assurance standards for at least 6 consecutive months.
No corrective action within the last 6 months.

Responsibilities

Serves as the account representative for Hoag in working with insurance companies, government payors, and/or patients for resolution of payments and accounts resolution.
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 Hoag.
Reviews and completes payor and/or patient correspondence in a timely manner.
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 direct supervisor for review and resolution.
Interprets Explanation of Benefits (EOBs) and Electronic Admittance Advices (ERAs) to ensure proper payment as well as assist and educate patients and colleagues with understanding of benefit plans.
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, applicable professional and employee discounts.
May process bankruptcy and deceased patient accounts.
Consistently meets individual productivity and quality assurance standards.
Assists in multiples 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.
Provides support and assists 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.
Performs other duties as assigned.