Worker's Comp. No Fault & PIP Collector

Hudson Regional Hospital•Clifton, NJ

3d•$20 - $28

About The Position

This role involves performing billing functions to review and resolve billing errors, ensuring clean claim submission. The collector will work directly with third-party payers, internal and external customers, and contract clients to achieve efficient collection results on assigned accounts, adhering to departmental policies and procedures. A thorough knowledge of third-party billing and collection requirements for assigned payers is essential, along with the ability to utilize all available resources, including electronic inquiries for eligibility, benefits, and claim status. Good judgment is required for account resolution, with all activity documented clearly and accurately in the appropriate online system. The collector must also demonstrate excellent customer service skills, reconcile payments and contractual allowances, resolve credit balances, and advise the team lead or supervisor of any billing errors, payer trends, denials, or payment fluctuations. Adherence to all hospital regulations, including HIPAA, and hospital policies and procedures (Attendance Management, Rules of Conduct, HIPAA, Dress Code) is mandatory. The role also requires meeting previous year's goals or performance improvement plans and performing other assigned duties.

Requirements

Knowledge of insurance billing in the following areas: Workers’ Compensation and Motor Vehicle claims
Ability to work well independently and communicate efficiently and respectfully with patients and insurance representatives.
Must have experience with Workers compensation and No-Fault PIP in New York and New Jersey
Be able to negotiate settlements
Be able to communicate with law firms that are processing arbitrations on behalf of Hospital
Maintains a thorough knowledge of third party billing and collection requirements for payers assigned for handling.

Responsibilities

Performs billing functions to review and take necessary actions to resolve billing errors ensuring clean claim submission.
Work directly with third party payers, internal and external customers, and other contract clients toward effective and efficient collection results on accounts assigned by management in accordance with departmental policy and procedures.
Identify billing errors and denials, by understanding the problem and resubmit corrected claims or take other appropriate action to resolution.
Send appeals for: low reimbursement, no authorizations, timely filing, medical necessity etc. with correct documentation.
Submit paper claims to primary and secondary insurance with correct documentation, ie: operative reports, implant invoices, primary eob’s.
Adjust claims for correct fee schedule, incorrect payments and patient responsibility.
Scan work and correspondence daily and maintain clear detailed notes.
Utilizes all resources available, including electronic inquires to verify eligibility, benefits and claim status.
Exercises good judgment towards account resolution and documents all activity on account in a clear, accurate and consistent manner utilizing appropriate online system.
Work correspondence, explanation of benefits and remittance advice daily ensuring a 72-hour turnaround period is met.
Demonstrates excellent customer service skills when responding to incoming or outgoing calls in a most courteous manner providing clear and appropriate information as needed.
Demonstrates the ability to reconcile payments and contractual allowances when reviewing accounts in order to ensure the accuracy of the account balance.
Resolves credit balances in accordance to departmental policy and procedure.
Advise team lead and/or supervisor of any billing errors, payer trends in claims processing, denials or payment fluctuations, to ensure proper handling and escalation as necessary.
Adhere to all Hospital Regulations associated with Compliance (to include HIPPAA etc.).
Is knowledgeable of and adheres to all hospital policies and procedures including but not limited to: Attendance Management: Reports to work on time; is flexible when staffing needs warrant change; requests time off in a timely manner; consistently utilizes time clocks to document in and out shifts. Rules of Conduct: Respects the rights and property of others; does not engage in Harassment or Violence in the Workplace. HIPPA: Maintains confidentiality of patients, staff and visitors at all times. Dress Code: Complies with dress code policy and wears ID at all times.
Successfully completed previous year’s goals or performance improvement plan.
Performs other duties as assigned.