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- 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 Remittance Advices (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.
- Minimum of 3 years' experience doing AR follow up with 50 claims per day
- Working knowledge of Epic Resolute, Eric Care, and Epic CPOE.
- Intermediate Excel knowledge is a must.
Collector II - Costa Mesa, United States - ICONMA
Description
: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.