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Keck Medicine of USC · 4 weeks ago

Collector, Management Services Organization/Centralized Billing Office - CBO - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

Alhambra, CA

Full-time

Onsite

Entry, Mid Level

$25/hr - $39.69/hr

2+ years exp

Keck Medicine of USC is seeking a Collector Appeal Specialist responsible for processing inpatient and outpatient claims to third-party payers and private payers while ensuring compliance with billing guidelines. The role involves maintaining productivity standards, conducting quality control checks, and supporting billing operations to achieve optimum customer satisfaction.

Health CareHospitalService IndustryWellness

Responsibilities

Analyzes and determines which billing procedure should be followed, based upon the type of financial class, e.g., contracts, private insurance carrier, HMOs, government programs, Federal/State/Local, Self-Pay accounts in conjunction with type of billing: transplants, grants, trauma and indigent programs, LOAs, MSP billing

Analyzes the information submitted by the various departments for billing and the appropriate documentation required for processing a claim form whether submitted hard copy or electronically

Understands all billing vendors used by the MSO - CBO

Contacts by telephone or e-mail the appropriate departments to obtain the required information needed to process a claim

Analyzes the pre-printed information on the claim form(s) or billing system to ensure that it is accurate and consistent with other information contained in Cerner or patient accounting system and makes corrections as necessary

Edits charges on the claim form(s) or billing system for which departmental and payer guidelines stipulate should not be billed to the sponsor

Recomputes the total amount due prior to submitting the claim e.g. edits unbillable charges for all payors

Reviews the claim forms to identify sensitive diagnosis information and follows guidelines and procedures established by the department to maintain patient confidentiality

Review Charges/Encounter Forms for accurate billing information and assure that data fields are correct

Inputs all the required information needed to complete the claim, edit accordingly and submit either hardcopy or electronically, with all the required documentation. i.e. authorizations, reimbursement based on LOAs, medical records, sterilization consent forms, treatment authorization requests, authorizations, hysterectomy consent forms, Inpatient/Outpatient TARs and SARs, and ABN’s, and CMS certs and recerts

Obtains and reviews the medical record or on-line reports for additional documentation to be attached to hardcopy claim forms

Transmits claims via electronic vendor, once all corrections and adjustments have been processed

Submits completed claim forms to appropriate carriers with all required supplemental documentation

Submits hard copy claims via certified mail

Works and resolves reject for all assigned claims daily

Bills for late charges as needed

Communicates identified billing issues and trends to Supervisor and Billing Manager in a timely manner

Communicates issues with claim scrubber edits to Supervisor and Billing Manager in a timely manner

Communicates issues that impact bill holds with outside vendors: i.e. CMRE/RSI Collection Agencies to reporting manager Utilize CPT, ICD-10-CM, HCPCS, Insurance Directories and other insurance books as well as Cerner, AIDX/GE and other systems to solve billing issues and problems

Utilize all systems as applicable

Follow-up and collect on accounts for all payors, including Medicare, Medi-Cal, commercial, guarantor, and other contracted payors

Primary follow-up assignment is to facilitate payment for accounts previously billed

Review each patient’s case, correspondence, and current computer data to determine possible payment problems

Maintain “portfolio” of such accounts with optimum cash collections, adjustments and closures

Perform follow-up on all outstanding insurance claims

Document all activity

Manage and process assigned computerized (i.e., ETM, etc.) or manual worklist in a timely manner to ensure that MSO CBO achieves its overall collection standards and quality measures

Call appropriate third-party contacts and establish specific reimbursement status, i.e. reason for any discrepancy between expected and actual reimbursement amount and date of issuance

Be aware of courtesy rates and/or courtesy adjustments

Submits necessary adjustments using the correct debit or credit transaction in order to correct account balance and/or claim totals prior to submission

Submits adjustments with appropriate codes

When circumstances warrant, transfers all or parts of a patient account charges to the correct account

Submits charge corrections and/or combines charges correctly via patient accounting system

Updates case / payer data and documents the reason for the updates; requests rebills as necessary

Submits adjustment requests to immediate Supervisor for review and approval

Applies proficiency in understanding and applying contractual terms of our Managed Care contracts (i.e., PPO, HMO, EPO, POS, Medi-Cal, Medicare, etc.)

Applies knowledge of Cerner, AIDX/GE and other systems Demonstrates knowledge in various payor websites

Documents claim bill date, billed amounts, billing address, billing attachments, invoice number, expected payment, contractual amount, received payments, actual transplant date(s), type of transplant, pre and post periods for transplant days, and all pertinent billing data relevant to billing the claim

Documents in a clear, concise and grammatically correct manner in system folder notes

Uses appropriate collector comment codes

Meets Production and Quality Review Standards set by Team Supervisor and Billing Manager

Reviews patient accounts and back up documentation to determine the nature and extent of delinquency problems and any actions taken by patients or third-party payors

Communicates with billing office staff to obtain additional information as needed

Provides feedback and guidance to office staff regarding coding, claim appeals, authorizations and diagnosis requirements

Contacts government and third-party payors and/or patients to facilitate timely payment of past due charges; arranges alternative settlement plans as needed

Responds to third-party payors or patient inquiries in a timely manner

Reviews Explanation of Benefits from government and third-party payors to determine if payment was made correctly and if denials can be re-billed

Identifies problem delinquencies and recommends appropriate course of action, such as referral to outside collection agency, legal action or write off

Requests transfers and/or adjusts patient accounts; Requests small balance write offs

Requests necessary adjustments with appropriate payment/adjustment codes, using the correct debit or credit transaction, in order to correct account balance and/or claim totals and to assure the account balance is correct when the refund is released

Prepares, analyzes and maintains records and reports documenting the status and amount of past due accounts and the timing and nature of their disposition

Updates billing system, GE Centricity Business (GECB) with clear, detailed, concise ETM Task notes regarding activity related to resolution of balances, i.e. claim status, payment pending, adjustments needed, etc

Reviews own work prior to taking appropriate action

Attends seminars and professional association meetings; reads pertinent literature to maintain current knowledge of collection policies and procedures and related legislation

Works off various ad hoc reports for special projects, as needed and directed

Reviews and responds to claim edits and eCommerce edits daily

Reviews payment transactions and researches payment correction requests

Processes adjustments, payment corrections and transfers where applicable

Researches misapplied payments

Audits patient accounts to determine appropriate action, i.e. adjustments, payment corrections

Verifies patient and insurance responsibility

Updates billing system, GE Centricity Business (GECB) with clear, detailed, concise ETM Task notes regarding activity related to resolution of credit balances, i.e. payment transfers, adjustments, and/or refund requests, etc

Reviews own work prior to taking appropriate action to resolve credit, i.e. payment transfers, adjustments or refund requests

Accesses and works off credit balance views in ETM in GECB (billing system) daily

Works off various ad hoc reports for special projects, as needed and directed

Applies knowledge of GECB, Cerner, MARS Refunds App and daily ETM views to review and resolve credit balances

Prioritizes working credit balances based on age of credit, in order to comply with the Office of Compliance’s Policy on Credit Balances

Stays informed of new developments and technologies by reading journals and other pertinent publications, maintaining contact with vendors, and participating in professional organizations, meetings and seminars

Performs other duties as assigned

Assists in special projects or other duties as assigned

Meetings, general support to other areas and office activities

Attends training classes

Assists in training co-workers if needed

Qualification

Medical services collectionsBilling proceduresCPTICD-10-CMHCPCSComputerized billing systemsCommunication skillsProblem identificationUser support experienceExpert skill-levelFire Life Safety TrainingDetail-oriented

Required

High school or equivalent

Experience with medical services collections for any combination of payors (Medicare, Medi-Cal/Caid, HMO, PPO, Commercial, and Private Pay)

Excellent communication skills both written and oral, detail knowledge of applicable collection laws/policies/principles/etc., governing collection efforts, problem identification and resolution, insurance, medical terminology, and reimbursement procedures

Expert skill-level in specialty area

Experience in computing environments

User support experience with servers, operating systems, workstations, networks, LANs and network software

Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)