Senior Managed Care Collector

Job Summary:

Responsible for collecting on assigned accounts in a professional and timely manner. Work with Insurance companies and other payors to resolve accounts efficiently. Responsible for High Dollar Managed Care accounts. Have the ability to help reduce aging AR. Work with Manager on special projects. Assist Manager in the absence of the Lead. Must be able to multi-task and have knowledge of contract language. Actively and consistently contributes to department operations and communications, behaves in a manner consistent with the mission, vision, and values of Pipeline Health, upholding standards of AIDET (Acknowledge, Introduce, Duration, Explanation, Thank you) patient communication.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

Essential Functions:

• Demonstrates competency in the quality of work and knowledge of the job pertinent to the functioning of the position of Sr Collector.
• Follow up on High Dollar accounts within 30 to 40 days from billed date.
• Follows up on all accounts after billing until payment is received.
• Reviews and follows up on aged accounts with documentation in an efficient and thorough manner with accuracy.
• Ensures appropriate phone calls/or website status towards resolution on each account.
• Demonstrate the ability to trend Payer issues and share with co-workers.
• Demonstrate the ability to create follow-up claim status spreadsheet for payors.
• Complete and update all Payer spreadsheets accurately and timely.
• Attend Payer conference calls timely.
• Take notes on Payor’s conference calls.
• Complete any action items pending from Payor’s conference calls.
• Produce ATB’s/Reports as needed.
• Ensures re-bills to payors as needed and change update to correct plan IDs.
• Work closely with the clinical appeal nurse to ensure all appeals are follow-up within 30 days from sent date.
• Meet with clinical appeal nurse monthly to exchange any new information.
• Prepares appeals on denials and underpayments as needed.
• Mails follow-up letters to patients/ insurance companies as needed.
• Consistently exercises sound judgment in arranging account settlement plans.
• Prepares accounts settlement options in a clear and persuasive manner.
• Works accounts on work ques/reports provided, averaging a minimum of 35 per day.
• Demonstrate the ability to reduce aging AR.
• Attend payor and Vendor webinars as needed.
• Handles all clients in a courteous and professional manner.
• Learn contract expected payments calculations for underpayment appeals.
• Ensures contractual/discounts are applied to accounts as specified in each contract.
• Refers an account to a biller and forwards a copy of the primary carrier’s EOB if a secondary insurance is applicable.
• Follows up on all correspondence requiring action as needed.
• Retrieves Patient records from the HBF system as needed.
• Demonstrates the ability to recognize and deal with priorities to complete work in a timely manner.
• Work with Manager and or Lead on special projects.
• Assist Manager in the absence of Lead.
• Performs all other duties and special projects as assigned.
• Basic unit/department maintenance such as keeping files, drawers, cabinets free from unnecessary clutter.
• Abides by HIPAA (Health Insurance Portability and Accountability Act) regulations.
• Completes and attends monthly training assigned.

Behavioral Standards:

• Exhibits customer and service-oriented behaviors in everyday work interactions.
• Demonstrates a courteous and respectful attitude to internal workforce and external customers.
• Communicates accurately and appropriately.
• Works well and efficiently under minimal supervision.
• Handles difficult situations in a discreet and professional manner.
• Is adaptable to changes in assignments and priorities.

Communication/Knowledge:

• Wears nametag properly; follows dress code policy; answers phone correctly and promptly; is prepared for meetings; meets deadlines; does not participate in gossip; acts ethically and treats others with respect; respects customer’s and co-worker’s time; establishes and maintains effective relationships with customers and co-workers.
• Provides accurate and timely written and verbal communication of information in a manner that is understood by all.
• Able to listen, understand, problem-solve, and carry-out duties to ensure the optimal outcome.
• Able to use IT systems in an accurate and proficient manner

Collaboration/Teamwork:

• Contributes toward effective, positive working relationships with internal and external colleagues.
• Demonstrates cooperation, flexibility, reliability, and dependability in all daily work activities and a willingness to collaborate with others for the good of the customer and the organization.

Qualifications/Experience: 

• At least two (2) to three (3) years of current experience in an acute care hospital setting, preferred.
• Knowledge of contracts.
• Computer skills, preferred.