Medical Collections Administrator II

Medical Collections Administrator II

The Medical Collections Administrator II is responsible for effective and efficient accounts receivable management of assigned payors. The collections efforts on outstanding accounts includes: telephone contact with payers as well as patients, working high volume collection reports and correspondence, auditing accounts, appealing denied claims as necessary, updating accounts as needed, identifying carrier related denial trends and consistently meeting departmental productivity standards. The incumbent performs required tasks on internal software as well as the Master Database, electronic claims vendors' software and various applications as well as using the internet to access payor websites. Extensive high volume collections experience with HMO's, PPO's, Workers Comp, Medicare and Medicaid. Prior Medical Collections experience, in a production-driven environment is fundamental for success in this role. The successful individual must also be able to communicate and collaborate effectively with other internal as well as external resources in order to achieve desired results and resolve issues.

Qualifications

• Associate's degree (A. A.) or equivalent from two-year college or technical school; or three to five years related experience and/or training; or equivalent combination of education and experience.
• Prior Medical Collections experience, in a production-driven environment is fundamental for success in this role.
• The successful individual must also be able to communicate and collaborate effectively with other internal as well as external resources in order to achieve desired results and resolve issues.
• Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume.
• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
• Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Ability to write routine reports and correspondence.
• Understanding of medical terminology and protocols.

Responsibilities

• Ensures that claims are processed accurately through review and audit functions to ensure timely payment. Responds to inquiries regarding claims with under payment or non-payment. Responds to inquiries, questions, and concerns from patients regarding the status of claims in a clear, concise, and courteous manner. Interfaces with external and internal customers to ensure optimal efficiency of service.
• Monitors aging of claims to ensure timely follow-up and payment.
• Coordinates, monitors, and manages the follow-up on unpaid claims. Ensures follow-up and reimbursement appeals of unpaid and inappropriately paid claims. Ensures appropriate documentation of billing, follow-up, collection, and appeal efforts are recorded on accounts.
• Identifies, researches, and ensures timely processing of billing errors and corrections as they relate to claims. Actively participates in problem identification and resolution and coordinates resolutions between appropriate parties. Reviews error codes associated with claims to ensure correction, resubmission, and subsequent payment. Analyzes common errors to support quality assurance efforts. Ensures corrected claims are sent out and monitored for payment.
• Maintains a working knowledge and understanding of CPT and ICD-10 codes. Keeps current with health care practices and laws and regulations related to claims collections through participation in professional development activities.
• Prepares routine management reports, quality reports, and special reports as directed by supervisor. Communicates collection problems to supervisor and makes recommendations for changes.
• Performs assignments accurately and on time, as directed. Assists other accounts receivable staff with workload and provides back-up support in their absence. Maintains individual productivity and performance standards.
• Participates in administrative staff meetings and attends other meetings and seminars, as required. Assists in evaluation of reports, decisions, and departmental results in relation to established goals. Recommends new approaches, policies, and procedures to influence continuous improvements in department's efficiency and services performed.
• Serves as a member of the Accounts Receivable Department Team. Performs duties necessary to ensure the team's projects/goals are completed. Takes ownership of special projects, researches data and follows through with detailed action plans.
• Consistently adheres to MEDNAX, Departmental, Operational, Office and HR policies and procedures. Reports to work, meetings and professional obligations on time.
• Maintain strict confidentiality in accordance with HIPAA regulations and Company policy, including divulging any patient private health information (PHI) only on a need-to-know basis to payers requiring the information for claims payment processing.
• Performs other duties as assigned or requested.