Collector, Management Services Organization/Centralized Billing Office - CBO - Full Time 8 Hour[...]

The Collector Appeal Specialist is responsible for accurately processing inpatient and outpatient claims to third‑party payers and private payers, following all mandated billing guidelines. Responsible for ensuring timely filing, providing quality control checks on paper and electronic claims, processing tracers, denial and related correspondence, initiating appeals, and composing and submitting appeal letters for challengeable denial issues consistent with the latest American Medical Association Current Procedural Terminology. Must demonstrate a positive demeanor, good verbal and written skills, professionalism in appearance and approach, maintain consistent productivity standards, and sustain an average of 90% (score 9.0) or better on Quality Reviews. The Professional Billing Refund Collector is responsible for accurately reviewing credit balances and processing adjustments, transfers and refunds as needed. Helps in billing operations by providing support and research of misapplied payments, working as a member of the billing team to provide smooth operational flow and effective processes. Essential Duties

TECHNICAL DUTIES

Billing Tasks: Analyzes and determines the appropriate billing procedure based on financial class (e.g., private insurance, HMO, government programs, self‑pay). Reviews submitted information, ensures accuracy, edits charges, recomputes totals, and follows confidentiality guidelines. Inputs required information and submits claims electronically or by hard copy, including all documentation (authorizations, consent forms, etc.). Communicates billing issues and trends to Supervisor and Billing Manager. Utilizes CPT, ICD‑10‑CM, HCPCS, and Cerner or other billing systems. Follow Up – Collections: Collects on accounts for all payors, reviews patient cases, manages portfolios, and resolves outstanding claims. Calls third‑party contacts to determine reimbursement status, adjusts accounts, submits necessary adjustments, and maintains proper documentation. Demonstrates superior knowledge of managed‑care contracts and payer websites. Production and Quality Standards: Reviews patient accounts for delinquency problems, provides guidance on coding, appeals, authorizations and diagnosis requirements, and maintains accurate notes in system folder. Communications and Inquiries: Contacts payors and patients for payment, arranges settlements, and responds to inquiries promptly. Reviews Explanation of Benefits to determine accuracy and eligibility for re‑billing. Delinquency Management: Identifies problem delinquencies, recommends actions (outside agency referral, legal action, write‑off), and processes necessary adjustments with proper codes. Reporting and Record Maintenance: Prepares, analyzes and maintains records and reports on past‑due accounts, updates billing system entries, and reviews own work for correctness. Professional Development: Attends seminars and professional associations, reads literature, keeps knowledge current, and supports cross‑ training as needed. Other Duties: Assists in special projects or other duties, attends training, and supports other office activities. PREPARES, ANALYZES, AND MAINTAINS RECORDS OF CREDIT BALANCES AND REFUNDS, updating system notes and ensuring compliance with the Office of Compliance policy. RESOLVES CREDIT BALANCES: Applies knowledge of billing systems, prioritizes credit balances based on age, and processes refund requests and transfers. STAY INFORMED: Reads journals, studies vendor updates, and participates in professional development activities. OTHER DUTIES: Assists in special projects, attends training classes, and supports training of co‑workers. Required Qualifications High school diploma or equivalent. Experience with medical services collections for Medicare, Medi‑Cal, HMO, PPO, commercial, and private pay. Excellent written and oral communication skills, detail orientation, and knowledge of collection laws 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. Preferred Qualifications 2 years of medical services collections and experience with computerized billing systems such as IDX. Required Licenses/Certifications Fire Life Safety Training (LA City). If a card is not available upon hire, one must be obtained within 30 days and renewed before expiration. The hourly rate range for this position is $25.00–$39.69. USC considers a range of factors, including scope of responsibilities, experience, education, and market conditions, when offering employment. Apply online for consideration. #J-18808-Ljbffr Keck Medicine of USC