Senior Collections Representative Lead
About The Position
The Sr. Collections Representative Lead (Lead) is assigned job functions that parallel that of a Biller/Collector. The Lead has advanced knowledge of Government payer billing and collections and serves as a resource person to other staff members and management. The Lead is responsible for assisting with training, monitoring backlogs, and is assigned special projects. The Lead is responsible for both billing and collections, gathering and securing all information needed for billing, follow-up, and payment of accounts in accordance with specific payer guidelines, policies, procedures, and compliance regulations. A Biller/Collector is responsible for reviewing, correcting, and completing billings to ensure complete and accurate billing of Medicare, Medi-Cal, and/or Managed Medicare/Medi-Cal payers; calculating expected reimbursement to verify expected payments versus actual payments received; filing disputes with payers for denials and/or underpayments; and is accountable and responsible for accurate billing and reconciling accounts to closure. The Lead utilizes multiple databases and applications to analyze and take appropriate action on information or documents received. Applications and Databases include EPIC, Hospital Rates, CIRIUS, RevCyclePro, Imaging, DDE, and various payer websites. Frequent contact with Patient Financial Services staff, departments, and management, as well as patients, billing, and professional fee and collection services vendors.
Requirements
- High school graduate or GED certificate.
- Four or more years of experience in a hospital billing office environment.
- Knowledge of contracts, insurance billing requirements, UB04 claim forms, Medicare, Medi-Cal and compliance program regulations.
- Good analytical and organizational skills, interpersonal, verbal, and written communication skills.
- Knowledge of computer operation, keyboard functions, calculator, copier and fax machine operation.
- Adequate keyboard skills.
- Proactive and assertive account resolution skills.
- Must be a motivated individual with positive and exceptional work ethics.
- Ability to follow directions and written procedures.
- Ability to balance assertiveness with compassion for the patient and others.
- Must have a thorough understanding of CPT, ICD, DRG, and HCPC codes.
- Must have a thorough understanding of stop losses, per diems, carve-outs and other contract terms and conditions.
- Computer software skills (i.e. Microsoft Applications and E-mail, etc.).
- Must demonstrate an in-depth understanding of all aspects of billing greater than an Office Assistant III and Senior Collections Rep I. (Note: This requirement applies only to UCSF Internals applicants only.)
Nice To Haves
- Medical terminology experience.
- ICD, CPT4, HCPCS, DRG coding experience.
- Understanding of HIPAA rules and regulations.
Responsibilities
- Assisting with training.
- Monitoring backlogs.
- Assigned special projects.
- Responsible for both billing and collections.
- Gathering and securing all information needed for billing, follow-up, and payment of accounts in accordance with specific payer guidelines, policies, procedures, and compliance regulations.
- Reviewing, correcting, and completing billings to ensure complete and accurate billing of Medicare, Medi-Cal and/or Managed Medicare/Medi-Cal payers.
- Calculating expected reimbursement to verify expected payments versus actual payments received.
- Filing disputes with payers for denials and/or underpayments.
- Accountable and responsible for accurate billing and reconciling accounts to closure.
- Utilizing multiple databases and applications to analyze and take appropriate action on information or documents received.
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What This Job Offers
Career Level
Senior
Education Level
High school or GED
