The Collector's main role is to collect on outstanding Accounts Receivable for assigned payers or institutions, contributing to increased cash collections and improving upon reimbursement rates to meet department goals. The Collector will work claims or invoices off of an aging report (claims aged between 45-120 days), work with both commercial and government payers, review EOB's and medical policy to evaluate and submit for appeals as applicable, as well as perform in-depth research to appropriately obtain coverage for any denied claims or invoices.
1. Meets the department's production and quality goals (measured hourly and daily) for cash collections, reduction in A/R aging buckets and overall risk for bad debt write-offs
2. Creates notes on the patients or client account for auditing and actions taken per the Standard Operating Procedures or as outlined by the team manager
3. Works the total patient accounts outstanding A/R including credits and denials to reduce A/R aging buckets per the department's goals
4. Researches and understands different payer policies and reimbursement history to improve ability to successfully overturn claim denials through the claims process
5. Understands the various company products and tests and can present reasonable arguments for medical necessity on behalf of the patient in order to obtain coverage from the insurance payer
6. Works hand in hand with the other team members to correct errors, communicate with team members about payer policy updates and improve work flow processes (e.g. billing integrity)
7. Send corrected claims and appeals based on payer guidelines in a timely manner
8. Make small balance write-offs or adjustments on accounts when applicable
9. Communicate problems and trends to leads or supervisors in order to escalate large payer or claims issues and follow through on resolution
10. For institutional collectors: ensures institutional invoices are sent to the appropriate recipient and follows up in a timely manner to ensure institutional accounts are making payments in accordance with contract timelines
11. Other projects as assigned
Education and Knowledge:
- High school diploma plus some college preferred
- Experience in appeals and audits a PLUS!
- Knowledge of CPT codes, medical terminology, insurance plans, ICD 10 codes
- Must have ability to adapt to a fast paced, dynamic environment
We are an equal opportunity employer and make hiring decisions based on merit. Recruitment, hiring, training, and job assignments are made without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, or any other protected classification. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.