Medical Collector - PB Commercial Denials

Job Summary Your job is more than a job The Collector is responsible for Collections and Denial Management ensuring the appropriate action is taken on assigned accounts in a timely manner resulting in positive resolution. Your Everyday Maintains responsibility for accurate and timely completion of daily follow-up or denial account assignment Identifies and analyzes underpayments to identify reasons for discrepancies and process denials and appeals as needed Reviews posted payments and adjustments to ensure accuracy. Analyzes EOBs to ensure proper reimbursement Conducts relevant research to complete appeals process to include assessing, complete and accurate documentation, tracking, responding to, and / or resolving appeals with third party payers in a timely manner Communicates with payers on outstanding claims, resolves payment variances and achieves timely reimbursement Accurately documents all activity on the patient account Collaborates with internal departments and external organizations to ensure correct reimbursement and resolve appeals Monitors underpaid and denied claims for trends and to identify root causes and reports findings to supervisor Demonstrates initiative and resourcefulness by making recommendations and communicating trends and issues to management Observes best practice processes in follow-up and customer service activities Participates in staff training that aligns with recognized improvement opportunities and increase understanding of Medicare/Medicaid requirements as well as general follow-up processes Acts in accordance with LCMC’s mission and values, while serving as a role model for ethical behavior Adheres to federal and state regulations related to the protection of patient information (e.g., the Health Insurance Portability and Accountability Act (HIPAA) as well as facility-specific guidelines) Experience Qualifications Minimum two years Of experience in a healthcare environment, particularly in healthcare billing, collections, payment processing, or denial management is preferred Education Qualifications Required: A high school diploma or GED Skills and Abilities Must be able to pass basic computer skills test and system level training Working knowledge of system reports and the ability to analyze system information to determine the impact of possible changes Demonstrates knowledge of: Hospital and professional billing processes and reimbursement Third-party contracting Insurance protocols, delay tactics, systems, and workflows ERISA guidelines for denials and appeals Regulations related to denials and appeals Ability to take initiative by identifying problems, conceptualizing resolutions, and implementing change Possesses efficient time-management skills and proven ability to multitask under tight deadlines Demonstrates excellent customer service skills Effective writing and communication skills Strong comfort level with computer systems Work Shift Days (United States of America) LCMC Health Overview LCMC Health is a community. Our people make health happen. While our NOLA roots run deep, our branches are the vessels that carry our mission of bringing the best possible care to every person and parish in Louisiana and beyond and put a little more heart and soul into healthcare along the way. Celebrating authenticity, originality, equity, inclusion and a little “come on in” attitude is the foundation of LCMC Health’s culture of everyday extraordinary Your extras Deliver healthcare with heart. Give people a reason to smile. Put a little love in your work. Be honest and real, but with compassion. Bring some lagniappe into everything you do. Forget one-size-fits-all, think one-of-a-kind care. See opportunities, not problems – it’s all about perspective. Cheerlead ideas, differences, and each other. Love what makes you, you - because we do You are welcome here. Equal Opportunity Employer LCMC Health is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status, or any other characteristic protected by law. The above job summary is intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary. Simple things make the difference. #J-18808-Ljbffr LCMC Health