Collector I - Careers Integrated Resources Inc

Job Title : Collector I

Job Location: Costa Mesa, CA

Job Duration: 3+ Months Contract (Possible extension)

Pay range: $23/h to $25/h on w2

Responsibilities:

· The Collector serves as the account representative for Client 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 Client.

· 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 Advice (ERAs) to ensure proper payment as well as assist 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 of HMO, 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.