About this role
We are seeking Professional Physican Collectors (Level II and III) Remote locations only:
• Georgia • Iowa • Missouri • Nebraska • North Carolina • Tennessee • Texas • Utah • Wisconsin • Wyoming • Indiana
Primary Duties and Responsibilities
• 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 Benefits (EOBs) and Electronic Admittance 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. • 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. • Consistently meets individual productivity and quality assurance standards. • Performs other duties as assigned. • In addition to the above, the Collector II demonstrates proficiency 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.
Education and Experience
• High school diploma or equivalent required. • Three years of experience in a hospital/medical and/or related field or strong background in customer service. • Working knowlege of Epic Resolute, Eric Care, and Epic CPOE. • Intermedicate Excel knowledge is a must. License Required N/A License Preferred N/A Certifications Required N/A Certifications Preferred N/A