Medical Collector I

St Johns Community Health•Los Angeles, CA

About The Position

The Medical Collector I is a full-time position responsible for managing denials and collecting outstanding account receivables securing payment of denied claims for Medical, Dental, Optometry, Behavioral Health, OB-GYN, and Podiatry, claims. This is a challenging and rewarding position that requires strong communication skills, attention to detail, and the ability to work in a fast-paced environment. This position reports to the Billing Manager, in some cases, the focus may be on either coding or billing but must be cross trained in both. Benefits: Free Medical, Dental & Vision 13 Paid Holidays + PTO 403 (B) retirement match Life Insurance, EAP Tuition Reimbursement Flexible Spending Account Continued workforce development & training Succession plans & growth within Qualifications/Licensure: Education, Experience, & Knowledge Three (3) years of experience with revenue cycle operations management with excellent presentation and writing skills. Advanced skills in analysis and MS Office suite. eClinical Works experience is preferred. High School diploma or GED required. Billing Certification required. Demonstrated knowledge of all Insurance companies, HMO’s, PPO’s Government and State programs Medi-Cal and Medicare, and third-party payers. Experience with managing revenue cycle processes including Medicaid and Medi-Cal eligibility, health information management and billing, and charge capture processes.

Requirements

Three (3) years of experience with revenue cycle operations management with excellent presentation and writing skills.
Advanced skills in analysis and MS Office suite.
High School diploma or GED required.
Billing Certification required.
Demonstrated knowledge of all Insurance companies, HMO’s, PPO’s Government and State programs Medi-Cal and Medicare, and third-party payers.
Experience with managing revenue cycle processes including Medicaid and Medi-Cal eligibility, health information management and billing, and charge capture processes.

Nice To Haves

eClinical Works experience is preferred.

Responsibilities

The billing department encompasses medical coding, charge entry, claims submissions, payment posting, accounts receivable follow-up, and reimbursement management.
Works through patient insurance documentation, billing and collections, and data processing to ensure accurate billing and efficient account collection.
Analyzes billing and claims for accuracy and completeness; submit claims to proper insurance entities and follow up on any issues.
Follows up on claims using various systems, such as eClinical Works, Claim Remedi clearinghouse, Medicare DDE, Online payer sites, etc.
Maintains contacts with other departments to obtain and analyze patient information to document and process billings.
Analyzes trends impacting charges, coding, collection, and accounts receivable.
Successfully scrubs and quality controls claims prior to submission.
Works the A/R, works rejected claims, and provides necessary follow-up to ensure successful claim processing.
Generate month end close patient financial communication letters and statements
Provide quality control checks of denied claims, the ability to process tracers, process contractual adjustments and allocation of funds; initiate appeals
Evaluate remittance to ensure accuracy and analysis of CAS and denial codes.
Maintains strong attention to detail and ability to multi-task.
Maintains extremely high standards of professional conduct.
Establishes and maintains effective working relationships with the office staff and Doctors.
Adheres to policies regarding safety, confidentiality, and HIPAA guidelines.
Ensures that the activities of the collection operations are conducted in a manner that is consistent with overall department protocol and are in compliance with Federal, State, and payer regulations, guidelines, and requirements.
Serves as a practice expert and go-to person for denials questions and advice.
Performs other job duties as assigned.