Collector

LCMC Health•Irvine, CA

About The Position

Your job is more than a job This job description is intended to describe the general nature and level of work performed by employees assigned to this department. This is not an exhaustive list of all duties and responsibilities, and LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary. GENERAL DUTIES Maintains responsibility for accurate and timely completion of daily follow-up or denial account assignment. Identifies and analyzes underpayments to identify reasons for discrepancies and process denials and appeals as needed. Reviews posted payments and adjustments to ensure accuracy. Analyzes EOBs to ensure proper reimbursement. Conducts relevant research to complete appeals process to include assessing, complete and accurate documentation, tracking, responding to, and / or resolving appeals with third party payers in a timely manner. Communicates with payers on outstanding claims, resolves payment variances and achieves timely reimbursement. Accurately documents all activity on the patient account. Collaborates with internal departments and external organizations to ensure correct reimbursement and resolve appeals. Monitors underpaid and denied claims for trends and to identify root causes and reports findings to supervisor. Demonstrates initiative and resourcefulness by making recommendations and communicating trends and issues to management. Observes best practice processes in follow-up and customer service activities. Participates in staff training that aligns with recognized improvement opportunities and increase understanding of Medicare/Medicaid requirements as well as general follow-up processes. Acts in accordance with LCMC Health’s mission and values, while serving as a role model for ethical behavior. Adheres to federal and state regulations related to the protection of patient information (e.g., the Health Insurance Portability and Accountability Act (HIPAA) as well as facility-specific guidelines.

Requirements

High School Diploma/GED or equivalent OR 2 years of work experience in healthcare particularly in billing, collections, payment processing, or denial management is preferred.

Responsibilities

Maintains responsibility for accurate and timely completion of daily follow-up or denial account assignment.
Identifies and analyzes underpayments to identify reasons for discrepancies and process denials and appeals as needed.
Reviews posted payments and adjustments to ensure accuracy.
Analyzes EOBs to ensure proper reimbursement.
Conducts relevant research to complete appeals process to include assessing, complete and accurate documentation, tracking, responding to, and / or resolving appeals with third party payers in a timely manner.
Communicates with payers on outstanding claims, resolves payment variances and achieves timely reimbursement.
Accurately documents all activity on the patient account.
Collaborates with internal departments and external organizations to ensure correct reimbursement and resolve appeals.
Monitors underpaid and denied claims for trends and to identify root causes and reports findings to supervisor.
Demonstrates initiative and resourcefulness by making recommendations and communicating trends and issues to management.
Observes best practice processes in follow-up and customer service activities.
Participates in staff training that aligns with recognized improvement opportunities and increase understanding of Medicare/Medicaid requirements as well as general follow-up processes.
Acts in accordance with LCMC Health’s mission and values, while serving as a role model for ethical behavior.
Adheres to federal and state regulations related to the protection of patient information (e.g., the Health Insurance Portability and Accountability Act (HIPAA) as well as facility-specific guidelines.