Medical Collections Authorizations Rep 24-00807 - Alura Workforce Solutions
Los Angeles, CA 90010
About the Job
Position
Medical Collector / Authorizations Rep
(Physician Claims)
Description
The Revenue Cycle Support Services Associate I coordinates and performs all collections follow up on Medi-Cal/CCS denied authorizations and if ncessary requesting new and/or modified authorizations from both automated and manual payers in accordance with training materials, scripts, and standard operating procedures. Position also performs a variety of duties which may include reviewing overpayments, credits, and recoupments. Other duties may include making phone calls and/or using payers web portals to check patient eligibility or confirming status of pending recoupments.
Essential Duties of the Position
• Follows up on Medi-Cal/CCS denied authorizations and if ncessary requesting new and/or modified authorizations from both automated and manual payers
• Reviews correspondences related to refunds and or recoupments.
• Work with Finance and other Revenue Cycle Departments to optimize the cash posting, balancing and reconciliation process.
• Responsible for evaluating credit balances and ensuring that refunds are issued to the appropriate payer in a timely and accurate manner.
• Ability to work special projects as needed by management.
• Investigate unapplied cash receipts and resolve or escalate in a timely manner to lead or supervisor.
• Reverses balance to credit or debit if charges were improperly billed.
• Contacts insurance carriers as necessary to determine correct payment application.
• Communicates issues related to payment posting and refunds from payers to management.
• Updates correct payer and resubmits claims to the appropriate payer(s).
• Consistently meets/exceeds productivity and quality standards.
• Performs other related duties as assigned by management team.
Requirements
1. Minimum (3) years healthcare experience in insurance verification, collections, cash posting and refunds, exposure to insurance verification, billing or collections required.
2. Knowledge of Medi-Cal, CCS-SAR payors and authorization guidelines required.
3. Familiarity with payer billing and reimbursement guidelines and regulation, including ability to read and interpret payer Explanation of Benefits (EOB), and Remittance Advice Details (RAD).
4. Proficient in all Microsoft Office software applications and EMR systems such as Athena.
5. Ability to communicate effectively in both written and verbal format with internal and external stakeholders.
6. Ability to organize and manage time effectively.
7. Handle, in a professional and confidential manner, all correspondence, documentation, and files following HIPAA and PHI guidelines.
8. Ability to be analytical, flexible, innovative, self-motivated, work independently and as a part of a larger team.
9. High Schoold Dimploma or equivalenet required
Additional Information
Full-Time, Monday - Friday
INDH
Medical Collector / Authorizations Rep
(Physician Claims)
Description
The Revenue Cycle Support Services Associate I coordinates and performs all collections follow up on Medi-Cal/CCS denied authorizations and if ncessary requesting new and/or modified authorizations from both automated and manual payers in accordance with training materials, scripts, and standard operating procedures. Position also performs a variety of duties which may include reviewing overpayments, credits, and recoupments. Other duties may include making phone calls and/or using payers web portals to check patient eligibility or confirming status of pending recoupments.
Essential Duties of the Position
• Follows up on Medi-Cal/CCS denied authorizations and if ncessary requesting new and/or modified authorizations from both automated and manual payers
• Reviews correspondences related to refunds and or recoupments.
• Work with Finance and other Revenue Cycle Departments to optimize the cash posting, balancing and reconciliation process.
• Responsible for evaluating credit balances and ensuring that refunds are issued to the appropriate payer in a timely and accurate manner.
• Ability to work special projects as needed by management.
• Investigate unapplied cash receipts and resolve or escalate in a timely manner to lead or supervisor.
• Reverses balance to credit or debit if charges were improperly billed.
• Contacts insurance carriers as necessary to determine correct payment application.
• Communicates issues related to payment posting and refunds from payers to management.
• Updates correct payer and resubmits claims to the appropriate payer(s).
• Consistently meets/exceeds productivity and quality standards.
• Performs other related duties as assigned by management team.
Requirements
1. Minimum (3) years healthcare experience in insurance verification, collections, cash posting and refunds, exposure to insurance verification, billing or collections required.
2. Knowledge of Medi-Cal, CCS-SAR payors and authorization guidelines required.
3. Familiarity with payer billing and reimbursement guidelines and regulation, including ability to read and interpret payer Explanation of Benefits (EOB), and Remittance Advice Details (RAD).
4. Proficient in all Microsoft Office software applications and EMR systems such as Athena.
5. Ability to communicate effectively in both written and verbal format with internal and external stakeholders.
6. Ability to organize and manage time effectively.
7. Handle, in a professional and confidential manner, all correspondence, documentation, and files following HIPAA and PHI guidelines.
8. Ability to be analytical, flexible, innovative, self-motivated, work independently and as a part of a larger team.
9. High Schoold Dimploma or equivalenet required
Additional Information
Full-Time, Monday - Friday
INDH
Source : Alura Workforce Solutions