Job Title : Collector I - Medical Biller

Facility : Hoag Memorial Hospital Presbyterian

Duration : 9 months

Location : 2995 Red Hill Ave, Suite 200 Costa Mesa, CA 92626

Schedule Notes : 8-430 pm

Pay : $25 - $32/Hour W2

Duties:

Position Summary:

-The Collector serves as the account representati ve for Hoag in working with insurance companies,government payors, and/or patients for resolution of payments and accounts resolution.

-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.

-Has a strong understanding of the Revenue Cycle processes, from Patient Access (authorizations admissions) through Patient Financial Services (billing & collections), including procedures and policies.

-Has 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 Admitt ance Advices (ERAs) to ensure proper payment as well asassist 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 ofHMO, 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.

-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.

Skills:

Required Skills & Experience:

-One year of previous hospital business experience, or equivalent required or strong background in customer service.

-Basic experience with insurance plans, hospital reimbursement methodology, and/or ICD10 and CPT coding.

Preferred Skills & Experience:

-N/A

Education:

Required Education:

-High school diploma or equivalent required.

Preferred Education:

-N/A

Required Certifications & Licensure:

-N/A

Preferred Certifications & Licensure:

-N/A