Collector Commercial - FT - Days
This position is responsible for activities leading to the collection of accounts receivable that are outstanding on the ATB, utilizing verbal and written communications with insurers, providers, employers, and other payers. This position requires being familiar with commercial, workers compensation, and liability third party payer reimbursement, and is accountable for getting those accounts collected.
POSITION EDUCATION/ QUALIFICATIONS:
- High school diploma/ GED is required
- Comprehensive knowledge of healthcare reimbursement
- Understands medical terminology
- Knowledge of Microsoft Office suite, working knowledge of Excel required
- Excellent Customer Service
- Good written and verbal communication skills required.
- Must be able to multi-task
- Ability to read, write and speak English.
- Ability to communicate clearly and concisely with all levels of management
- Previous healthcare experience (1-2 yrs.) is required, hospital experience preferred.
- Minimum of 1-2 yrs. experience with medical collections, managed care contract experience is preferred.
- Communicates clearly and concisely and is able to work effectively with other employees, patients and external parties
- Provides excellent customer service by establishing and maintaining long-term relationships with carrier reps.
- Demonstrates proficiency in Microsoft Office applications, be able to type at least 35 WPM, and good working knowledge of Excel is required.
- Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly.
- Ability to use the internet to obtain claim status with TMHP, FISS, MY Ability, and Third Party Payers.
- Requires working with minimal to moderate interruptions
- Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices
- Responsible for following up insurance accounts assigned on AEOS System and or ATB reports
- Contacts insurance carrier for payment on assigned accounts
- Follows-up on an average of 45 (225 weekly) accounts daily and completes 100% of the assigned accounts by the end of each week.
- Adheres to Governmental Billing and Collection payer rules and guidelines located in the Medicare/Medicaid manuals when contacting insurance carrier.
- Proficient in accessing information from AX or Cerner software
- Proficient in accessing the Medicare System-FISS, My Ability for eligibility and claim status and the Medicaid System-TMHP to obtain eligibility and claim status
- Proficient in attempting to update TPR segments as applicable with Third Party Payers
- Proficient in determining when a 121 and or 131 Type of Bill is required for Ancillary billing due to Medical necessity and or Exhausted Benefits; also includes to ensure accounts are sitting with appropriate payment, adjustment and patient balances
- Accurately utilizes AEOS system and or Email, when requesting additional information from within internal
or other departments
- Responsible to send AEOS RQs to Coding as needed for clarification on diagnosis, CPT , HCPCS, or Modifier
- Reviews accounts to ensure the appropriate insurance plan is set-up and the correct insurance adjustment was posted.
- Reads previous notes on the account and document new notes using appropriate mnemonic in the notes tab which is also posted into AEOS
- Familiar with managed care contract terms to determine appropriate reimbursement of insurance carrier
- Ability to compare the payer reimbursement to the expected payment in the computer and question any discrepancies with insurance carrier when on the phone
- Ability to identify accounts that need insurance billing or rebilling i.e., late charges, adjustments, patient related appeals
- Contacts physician’s office and request copies of documentation needed
- Request copies of medical records from HIM for any paper records as needed
- Ability to obtain electronic records from the Cerner system as needed
- Contacts patient to ensure all requested information for insurance company is provided. Ex. Pre-existing conditions, COB, accident details, or claim forms, etc
- Daily follow up on faxes or messages to carriers within 24 hours, to ensure the fullest collection effort is accomplished.
- Provide excellent customer service by responding to carriers or patient calls within 24 hours and documents activity on the patient account.
- Assist other collectors in collecting a difficult account as needed
- Select correct adjustment codes and amounts on adjustment letter to appropriately document reason for adjustment
- Notify management team of accounts that denied due to lack of medical necessity, etc, to be assigned nurse auditor for review of possible appeal; all accounts will have appropriate documentation
- Complete adjustment forms appropriately with the correct loss amounts and appropriate adjustment code with necessary backup, variable data to be completed as applicable
- Responsible to complete all tasks assigned daily.
- Follow the Best Business Practice outlined in the DHR Billing Specialist Priority Matrix-See attached.
- Adheres to the QA requirements process.
- Ensures patient confidentiality requirements are met in accordance with HIPAA policies and procedures.
- Other duties as assigned.
LINES OF REPSONSIBILITES:
- Supervisor → Manager → Director → Chief Revenue Officer