Accountant - Hospital

Collector II

Pride Health is hiring a Medical Collector for one of its clients in California. This is a 3-month contract with a possible extension with competitive pay and benefits. Location – Costa Mesa, California– 92626 Pay range - $24 - $28 per hour. Length of assignment – 3 months (With Possible extension) Shift – Monday-Friday 1st shift.

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

Job Duties

• 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 Client.
• Reviews and completes payor and/or patient correspondence promptly.
• 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 the 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, and understanding of terms and conditions, as well as Federal and State requirements.
• Interprets Explanation of Benefits (EOBs) and Electronic Remittance 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 familiarity 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, and 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

In addition to the above, the Collector II demonstrates proficiency in the functions mentioned above.

• Assists in multiple areas, payors, or departments.
• Assist with special projects and/or additional tasks as needed.
• Able to problem-solve issues as they arise and independently research as needed for resolution.
• Provide support and assist with training of peers as needed.
• Exceeds individual productivity and quality assurance standards for at least 6 consecutive months.
• No corrective action within the last 6 months.

Requirements

• High school diploma or equivalent required.
• Minimum of 50 claims per day doing insurance AR follow-up.
• Minimum of 3 years' experience doing AR follow-up.
• Three years of experience in a hospital/medical and/or related field or strong background in customer service.
• Working knowledge of Epic Resolute, Eric Care, and Epic CPOE.
• Intermediate Excel knowledge is a must.

Pride-Health offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance and employee discounts with preferred vendors.

Pride-Health is a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including, the California Fair Chance Act and all applicable local Fair Chance ordinances. We are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us.

Equal Employment Opportunity: Pride-Health is an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.