KP Payor Collector II (Part-Time)

Within Regional and Departmental Policies&Procedures and under direct supervision, this position is responsible for the collection of delinquent billed accounts and resolving outstanding receivables by performing collection and claim status follow-up activities, settlement negotiations, processing appeals, identifying and processing adjustments and other write-offs, and agency assignments for qualified accounts by processing and notating accounts in the host system.

Essential Functions:

• Determine appropriate collection action by processing accounts in assigned work queues (e.g., KPHC Work Queues, collector assignment report, aging reports, etc.).

• Responsible for follow-up&collection of accounts, including, but not limited to: inpatient, outpatient, emergency room,&pharmacy charges for all in-&out-of-network services, etc. by various means (systems, reports, etc.).

• Make recommendations as well as make decisions to refer accounts to appropriate line of business for billing/rebilling and/or outside collection agencies at any stage of the internal collection process.

• Review accounts to ensure compliance w/ applicable local, state, and/or federal law®ulations, including organization policies&procedures. 10

• Correspond w/ interested parties to resolve receivables via in-coming&out-going telephone, fax, mail, e-mail, telegram, and/or legal correspondence for accounts.

• Update accounts receivable systems&department databases that maintain detailed insurance&claim information for collection of accounts w/ appropriate account notes regarding follow-up activities&any appropriate account revisions.

• Effectively collect balances due w/ any applicable penalties&interest on assigned accounts.

• Responsible for gathering information, making recommendations related to adjustments of uncollectible balances&completing accounts appropriately.

• Identify accounts which require refunds, calculate refund amounts,&refer accounts to appropriate support staff.

• Respond to in-coming correspondence&telephone inquiries from patients, guarantors, third parties, attorneys,&other KP facilities or departments, etc. regarding accounts.

• Make referrals to appropriate departments to resolve any initial&supplemental billing issues.

• When necessary, work w/ staff of various business offices, insurance carriers, Corona Call Center, member service departments, provider areas&California Service Center (CSC) to facilitate corrections or other required revisions necessary to collect assigned accounts.

• Responsible for initiating out-bound collection calls&handling in-bound call volumes w/in the standard(s) established by the department.

• Achieve individual production&quality assurance performance w/in established expectations&standards.

• Comply w/ legalðical requirements to protect patient, employee,&KFHP confidentiality.

• Identify&communicate ways of improving department processes, procedures&customer relations by participating in Unit Based Teams&other Labor Mgmt Partnership processes.

• Interpret benefits, exclusions&accurate reimbursement levels of primary&secondary insurance coverage.

• Review&interpret Explanation of Benefits (EOB) to ensure all revenue-generating possibilities have been exhausted&take appropriate action, including but not limited to: posting adjustments, posting denials, processing appeals, changing financial classes, processing adjustments&write-offs, rebilling/secondary billing, etc.

• Responsible for electronic billing/paper billing&interface between KP billing facilities&external entities.

• Utilize documentation (e.g., settlement draft, settlement release, awards issued by the court) to ensure maximum case settlement&take appropriate action for the following: posting adjustments, posting denials, processing appeals, changing financial classes, processing revenue reversals, write-off, rebilling/secondary billing, etc.

• Assist w/ preparation of cases for litigation by collecting supporting documentation.

• Verification of pertinent account data (i.e., coverage, benefits, eligibility, authorization, etc.)that is required to facilitate collection activities and/or write-off recommendations.

• Perform other duties as assigned, including but not limited to, special projects.

• Note: Internal PFS candidates may have job advancement opportunities via the PFS Career Ladder,&should consult w/ their supervisor and/or manager.

This is a Repost of 300728.

Pay Grade: 18

Basic Qualifications:

Experience

• Minimum two (2) years experience as collector, biller, or customer service representative in related health care patient accounting field within the last four (4) years; OR combination of all three above; OR One (1) year of collector experience combined with a Line of Business Training Certificate for KFHP Collectors.

• The Basic Computer Literacy Assessment score must be current within one (1) year (contact Local HR Office for testing). Must obtain passing score on the Basic Computer Literacy Assessment (passing score set at 75).

Education

• High school diploma or GED.

• Basic minimum required experience/certifications OR successful completion of the PFS Career Ladder curriculum that is mapped to that position.

License, Certification, Registration

• N/A.

Additional Requirements:

• Ability to demonstrate knowledge of the Fair Debt Collection Practices Act and NAIC Guidelines; local, state, and/or federal Commercial laws and regulations; billing requirements, to include, but not limited to: ICD-9, CPT, and DRG codes, and fee schedule allowances and reductions; medical terminology and calculations necessary for account management.

• Ability to demonstrate knowledge of line of business specific billing and collection rules, regulations and other pertinent payer specific requirements.

• Demonstrated ability to work with patient accounting and computerized collection systems and use Windows operating system and Microsoft Office Applications (WORD, EXCEL, etc.).

• Demonstrated ability to utilize and apply active listening, communication, and persuasion skills, as well as the principles and processes needed to provide customer service.

• Ability to read, write and perform basic mathematical computations at a high school level.

• Ability to work well in a team environment and within the Labor Management Partnership guidelines and effectively participate in Unit Based Teams.

• Ability to lift 20 pounds. Ability to sit for long periods of time.

• Ability to use general office equipment including telephones, fax, copier, etc.

• Must be able to work in a Labor Management Partnership.

Preferred Qualifications:

• AA degree in Business or certification in insurance billing or collections issued by an accredited learning institution.

• Multi-lingual.

Notes:

• This is a Part-time, Non-benefitted position.