Collector-PFS On-Call / Appleas Unit


Pasadena, CA

What you'll be doing

The responsible person will be determine to appropriate collection by processing accounts in assigned work queues (e.g., Company Work Queues, collector assignment report, aging reports, etc.). Responsible for follow up and collection of accounts, including, but not limited to: inpatient, outpatient, emergency room and pharmacy charges for all in and 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 with applicable local, state and/or federal law and regulations, including organization policies and procedures. Correspond with interested parties to resolve receivables via in coming and out going telephone, fax, mail, email, telegram and/or legal correspondence for accounts. Responsible for gathering information, making recommendations related to adjustments of uncollectible balances and completing accounts appropriately. Identify accounts, which require refunds, calculate refund amounts and refer accounts to appropriate support staff. Respond to incoming correspondence and telephone inquiries from patients, guarantors, third parties, attorneys, and other company facilities or departments, etc. regarding accounts. Accountable for initiating out bound collection calls and handling inbound call volumes within the standard established by the department. Achieve individual production and quality assurance performance within established expectations and standards. Identify and communicate ways of improving department processes, procedures and customer relations by participating in Unit Based Teams and other Labor Management Partnership processes. Interpret benefits, exclusions and accurate reimbursement levels of primary and secondary insurance coverage. Responsible for electronic billing/paper billing and interface between company billing facilities and external entities. Utilize documentation (e.g., settlement draft, settlement release, awards issued by the court) to ensure maximum case settlement and 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 with preparation of cases for litigation by collecting supporting documentation.

What your background should be

Minimum two years of experience as a collector, biller or customer service representative in a related health care patient accounting field within the last four years or combination of all three above or one year of collector experience combined with a Line of Business Training certificate. 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. Demonstrated ability to work with patient accounting and computerized collection systems and use Windows operating system and Microsoft Office Applications (WORD, EXCEL, etc.). Must obtain passing score on the Windows XP assessment. The Windows XP assessment score must be current within one year. Certification in insurance billing or collections issued by an accredited learning institution preferred. Multilingual preferred.

Required Schooling / Training

Who is the client company

This is an integrated and the largest managed care organization in the United States.
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