Collector II

Job Description

Collector II

Pride Health is seeking a Collector for one of the large health systems based out of Costa Mesa, California.

Location – Costa Mesa, California– 92626

Pay range - $24 - $28 per hour.

Length of assignment – 3 months (With Possible extension)

Shift – Monday-Friday 1st shift.

Job Summary

The Collector serves as the account representative for the Client in working with insurance companies, government payors, and/or patients for the resolution of payments and accounts resolution.

Job Duties

· 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 Client.

· Reviews and completes payor and/or patient correspondence promptly.

· 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 the 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, and understanding of terms and conditions, as well as Federal and State requirements.

· Interprets Explanation of Benefits (EOBs) and Electronic Remittance 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 familiarity 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 me payment is due.

· May review for applicable cash rates, special rates, and 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 In addition to the above, the Collector II demonstrates proficiency in the functions mentioned above.

· Assists in multiple 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.

· Provide support and assist 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.

Requirements

· High school diploma or equivalent required.

· Minimum of 50 claims per day doing insurance AR follow-up.

· Minimum of 3 years’ experience doing AR follow-up.

· Three years of experience in a hospital/medical and/or related field or strong background in customer service.

· Working knowledge of Epic Resolute, Eric Care, and Epic CPOE.

· Intermediate Excel knowledge is a must.

· Diversity

· Technology & Equipment Skills

· Interpersonal Skills

· Job Knowledge

· Oral/Written Communication

· Travel

· Organizational behavioral Competencies

“Pride Global offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program,, legal support, auto,home insurance, pet insurance, and employee discounts with preferred vendors. “Company Description

Pride Health is a leading minority-owned healthcare recruitment & staffing firm that offers highly customized business process solutions at cost-effective prices.

Headquartered in New York City as a top minority supplier, PRIDE Health offers a broad geographic reach with offices throughout the U.S., India, and Brazil. Leveraging more than 20 years of experience, PRIDE has enhanced its core competency of IT staffing services by creating client-centric, cost-effective IT, and business process solutions. PRIDE serves Client-Partners in the healthcare, IT, financial services, retail and insurance industries offering both Direct Hire and Temporary Staff of Healthcare Professionals, Vendor Management Systems, IT Hardware Procurement Services, and Business Processing Outsourcing.

Temporary, Contract, Per Diem & Direct Hire staffing solutions are only part of what we can offer our clients.