Medical Collections Representative

MEDICAL COLLECTIONS REPRESENTATIVE SUMMARY

Works under the supervision of the Billing and Collection Supervisor. Analyzes and interprets Managed Care contract language, terms, conditions, and responsibility matrices. Performs telephone and written follow-up with patients, insurance companies, third party payers, worker’s compensation payers, medical groups, outside hospitals and physician’s offices to ensure timely payments. Has a strong understanding of CMS regulations, Managed Care and insurance company payment principles, rules, and regulations. Is knowledgeable with the use of appropriate HCPCS, CPT 4 codes, Modifiers, ICD9 and ICD10 codes. Understands the billing and payment follow up time limits set forth by Medicare, payer contracts and has the knowledge of insurance billing rules and regulations. Has the ability to utilize multiple hospital systems.

MEDICAL COLLECTIONS REPRESENTATIVE EDUCATION/EXPERIENCE/TRAINING

• High school graduate
• Previous experience working in an acute hospital patient account setting
• Minimum of 2 years’ experience in hospital collections
• Customer service experience.

MEDICAL COLLECTIONS REPRESENTATIVE DUTIES AND RESPONSIBILITIES

1. Safeguards and preserves the confidentiality of patient’s protected health information in accordance with State and Federal (HIPAA) regulatory requirements, hospital, and departmental policies.
2. Ensures a safe patient environment and adherence to safety practices per policy.
3. With consideration to age, employee utilizes the approved process to resolve biophysical, psychological, educational, and environmental needs of patient/significant other when administering care.
4. Audits and analyzes accounts to determine proper insurance reimbursements and contractual allowances.
5. Maintains portfolio of all accounts with the ability to meet the daily productivity standard.
6. Follows-up with payers documenting the patient accounts systems with concise information for account resolution.
7. Pursues underpayments and complete appeals, when necessary, in a timely manner providing accurate information to payer.
8. Reviews and analyzes denied claims to determine appropriate action, accurately requesting the correct contractual adjustment according to our Commercial and Managed Care contracts.
9. Responds timely to insurance correspondence.
10. Reviews insurance refunds processing the appropriate adjustments to assure account balance is accurate when the refund is processed.
11. Skilled in the usage of various computer systems (Meditech, TRAC) and other available tools (APC and APR/MS DRG). Allscripts/SFM, NThrive/Claims Management a plus.
12. Keeps current AB774 regulations regarding billing/collections.
13. Performs other duties as assigned.

Medical Collections Representative Pay: 

$23.00 - 28.00/hour depending on experience 

Medical Collections Representative Location: 

100% remote after first few weeks of  onsite training but must reside in California