Collector: Revenue Cycle Epic

Hoag•Newport Beach, CA

9h•$22 - $34•Remote

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 requires a strong understanding of the Revenue Cycle processes, from Patient Access (authorizations & admissions) through Patient Financial Services (billing & collections), including procedures and policies. 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 of hospital billing form requirements (UB04) and familiarity with the HCFA 1500 forms is also 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 essential. The Collector demonstrates knowledge of and effectively uses patient accounting systems, documents all calls and actions taken in the appropriate systems, and accurately codes insurance plan codes. They will establish a payment arrangement when patients are unable to pay in full at the time payment is due. The Collector may review for applicable cash rates, special rates, applicable professional and employee discounts, and may process bankruptcy and deceased patient accounts. Consistently meets individual productivity and quality assurance standards. In addition to the above, the Collector II demonstrates proficiency in the functions mentioned above, assists in multiple areas, payors or departments, and assists with special projects and/or additional tasks as needed. The Collector II is 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, and has no corrective action within the last 6 months.

Requirements

Professional Physican Coders (Level II and III)
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.
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.
Proficiency in the functions mentioned above (for Collector II).
Able to problem solve issues as they arise and independently research as needed for resolution (for Collector II).

Nice To Haves

Assists in multiples areas, payors or departments (for Collector II).
Assist with special projects and/or additional tasks as needed (for Collector II).
Provides support and assists with training of peers as needed (for Collector II).
Exceeds individual productivity and quality assurance standards for at least 6 consecutive months (for Collector II).
No corrective action within the last 6 months (for Collector II).

Responsibilities

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.
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.
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.