Collector II

The Collector serves as the account representative 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 Bene ts (EOBs) and Electronic Remittance Advices (ERAs) to ensure proper payment as well as assist and educate patients and colleagues with understanding of bene t 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 e ectively 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 me 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. -Consistently meets individual productivity and quality assurance standards In addition to the above, the Collector II demonstrates pro ciency in the functions mentioned above. -Assists in multiples areas, payors or departments. - Assist with special projects and/or additional tasks as needed. -Able to problem solve issues as they arise and independently research as needed for resolution. -Provides support and assists with training of peers as needed. -Exceeds individual productivity and quality assurance standards for at least 6 consecutive months. -No corrective action within the last 6 months.
Skills: Required Skills & Experience:-Three years of experience in a hospital/medical and/or related eld or strong background in customer service.-Working knowledge of Epic Resolute, Eric Care, and Epic CPOE.-Intermediate Excel knowledge is a must.-Diversity-Technology & Equipment Skills-Interpersonal Skills -Job Knowledge-Oral/Written Communication-Travel-Organization Behavioral Competencies-BUSINESS ACUMEN -CUSTOMER SATISFACTION -INNOVATION-TRUST & ACCOUNTABILITY
Preferred Skills & Experience:-N/A
Keywords:
Education: Required Education: -High school diploma or equivalent required