Responsibilities:

\nThe Collector serves as the account representation for Client in working with insurance companies, government payors, and/or patients for resolution of payments and accounts resolution.\nCompletes assigned accounts within assigned work queues.\nObtains 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.\nReviews and completes payor and/or patient correspondence in a timely manner.\nEscalates to the payor and/or patient accounts that need to be appealed due to improper billing, coding and/or underpayments.\nReports new/unknown billing edits to direct supervisor for review and resolution.\nHas a strong understanding of the Revenue Cycle processes, from Patient Access (authorizations admissions) through Patient Financial Services (billing & collections), including procedures and policies.\nHas thorough knowledge of managed care contracts, current payor rates, understanding of terms and conditions, as well as Federal and State requirements.\nInterprets Explanation of Benefits (EOBs) and Electronic Admit Advices (ERAs) to ensure proper payment as well as assist and educate patients and colleagues with understanding of benefit plans.\nUnderstanding of hospital billing form requirements (UB04) and familiar with the

HCFA 1500

forms.\nKnowledge of HMO, POS, PPO, EPO, IPA, Medicare Advantage, Covered California (Exchange), capitation, commercial and government payors (i.e. Medicare, Medi-Cal, Tri Care, etc) and how these payors process claims.\nDemonstrates knowledge of and effectively uses patient accounting systems.\nDocuments all calls and actions taken in the appropriate systems. -Accurately codes insurance plan codes.\nEstablishes a payment arrangement when patients are unable to pay in full at the time payment is due.\nMay review for applicable cash rates, special rates, applicable professional and employee discounts.\nMay process bankruptcy and deceased patient accounts.\nPerforms other duties as assigned\n

Requirements:

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