Collector III: Revenue Cycle Epic

Hoag•Costa Mesa, CA

2d•$25 - $39

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 the maximum amount of 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. Escalation to the payor and/or patient accounts that need to be appealed due to improper billing, coding and/or underpayments is also a key responsibility. The Collector will report new/unknown billing edits to 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 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 necessary. 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 required. 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 a payment arrangement when patients are unable to pay in full at the time payment is due is part of the role. The Collector may review for applicable cash rates, special rates, applicable professional and employee discounts, and may process bankruptcy and deceased patient accounts. Consistently meeting individual productivity and quality assurance standards is expected. The Collector will demonstrate proficiency in the functions of a Collector I & II, possess strong knowledge of carrier’s (Federal/State/Private) regulations and guidelines, assist peers and Supervisor/Manager with escalated situations, and actively participate in training and onboarding of new team members. Identifying ongoing training and recommendations for existing staff, as well as identifying and making recommendations for development of processes or protocol changes are also key aspects of this role. Exceeding individual productivity and quality assurance standards for at least 12 consecutive months and having no corrective action within the last 12 months are requirements for this position.

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.
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.
Strong knowledge of carrier’s (Federal/State/Private) regulations and guidelines.
Demonstrates proficiency in the functions of a Collector I & II.
Exceeds 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.