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Hoag Health System · 1 month ago

Collector I: Revenue Cycle Epic

Costa Mesa, CA

Full-time

Onsite

Entry Level

1+ years exp

Hoag Health System is a nonprofit regional health care delivery network in Orange County, California. The role of Collector I involves working with insurance companies and patients to resolve payment issues and ensure maximum reimbursement for the organization.

Hospital & Health Care

Responsibilities

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

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 Hoag

Reviews and completes payor and/or patient correspondence in a timely manner

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 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, understanding of terms and conditions, as well as Federal and State requirements

Interprets Explanation of Benefits (EOBs) and Electronic Admittance 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 familiar 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 time payment is due

May review for applicable cash rates, special rates, 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

Performs other duties as assigned