Collector III: Revenue Cycle Operations

Hoag•Costa Mesa, CA

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 the initial appeal for underpayments observing all timely requirements to secure reimbursement due to Hoag, and review and complete payor and/or patient correspondence in a timely manner. This position also escalates payor and/or patient accounts that need to be appealed due to improper billing, coding and/or underpayments, and reports 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. The Collector must have thorough knowledge of managed care contracts, current payor rates, understanding of terms and conditions, as well as Federal and State requirements. They will interpret 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. Understanding hospital billing form requirements (UB04) and familiarity with the HCFA 1500 forms is required. 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 is necessary. The role requires demonstration of knowledge of and effective use of patient accounting systems, documenting all calls and actions taken in the appropriate systems, and accurately coding insurance plan codes. The Collector will establish a payment arrangement when patients are unable to pay in full at the time payment is due. This role may also review for applicable cash rates, special rates, applicable professional and employee discounts, and may process bankruptcy and deceased patient accounts. The Collector must consistently meet individual productivity and quality assurance standards and demonstrate proficiency in the functions of a Collector I & II. Strong knowledge of carrier’s (Federal/State/Private) regulations and guidelines is required. The Collector will assist peers and Supervisor/Manager with escalated situations, actively participate in training and onboarding of new team members, identify ongoing training and recommendations for existing staff, and identify and make recommendations for development of processes or protocol changes. To be considered for this role, candidates must have exceeded individual productivity and quality assurance standards for at least 12 consecutive months and have no corrective action within the last 12 months.

Requirements

Strong understanding of the Revenue Cycle processes, from Patient Access (authorizations & admissions) through Patient Financial Services (billing & collections), including procedures and policies.
Thorough knowledge of managed care contracts, current payor rates, understanding of terms and conditions, as well as Federal and State requirements.
Ability to interpret Explanation of Benefits (EOBs) and Electronic Admittance Advices (ERAs) to ensure proper payment.
Ability to 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.
Demonstrated knowledge of and effective use of patient accounting systems.
Ability to document all calls and actions taken in the appropriate systems.
Ability to accurately code insurance plan codes.
Ability to establish a payment arrangement when patients are unable to pay in full at the time payment is due.
Proficiency in the functions of a Collector I & II.
Strong knowledge of carrier’s (Federal/State/Private) regulations and guidelines.
Exceeded individual productivity and quality assurance standards for at least 12 consecutive months.
No corrective action within the last 12 months.

Nice To Haves

May review for applicable cash rates, special rates, applicable professional and employee discounts.
May process bankruptcy and deceased patient accounts.
Assists peers and Supervisor/Manager with escalated situations.
Actively participates in training and onboarding of new team members.
Identifies ongoing training and recommendations for existing staff.
Identifies and makes recommendations for development of processes or protocol changes.

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.
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 ensure proper payment as well as assist and educate patients and colleagues with understanding of benefit plans.
Understands hospital billing form requirements (UB04) and is familiar with the HCFA 1500 forms.
Possesses 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, 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.
Demonstrates proficiency in the functions of a Collector I & II.
Strong knowledge of carrier’s (Federal/State/Private) regulations and guidelines.
Assists peers and Supervisor/Manager with escalated situations.
Actively participates in training and onboarding of new team members.
Identifies ongoing training and recommendations for existing staff.
Identifies and makes recommendations for development of processes or protocol changes.
Exceeds individual productivity and quality assurance standards for at least 12 consecutive months.
No corrective action within the last 12 months.