July 2, 2020
Location: Irvine, CA
Department: Billing and Collections
Reports To: Reimbursement Manager
FLSA Status: Non-Exempt
The Medical Collector/Patient Advocate Representative follows-up on the status of submitted claims and invoices; requests medical records as needed; prepares various medical appeals and the submissions of such appeals to insurance carriers; follows-up on all submitted medical appeals in a timely manner.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Collects money due from insurance companies, hospital and patients in compliance with CLIA, OIG and all other applicable legal requirements.
- Contacts insurance companies to follow up on claims and appeals which have been submitted, but no payment or correspondence received within the allotted time frame.
- Processes and follows up with patients for copays and deductible amounts due.
- Contacts clients to obtain medical records as needed for submission of a medical appeal or payer’s review of a claim.
- Prepares custom appeal letters and letters of interest to various insurance carriers and managed care groups.
- Reviews files to determine if amounts should be written off based on acceptable reimbursement, then forwards these to the Reimbursement Director.
- Investigates and prepares any necessary refund requests from payors for submission to the Reimbursement Director.
- Negotiates reimbursement single settlements with various insurance carriers and third party administrators, based upon department guidelines.
- Interfaces with insurance company representatives, doctor’s offices and hospitals regarding schedule of services and billing inquiries.
- Assists department director in the development of new procedures and systems to enhance productivity.
- Provides account information to the sales force as needed.
The above listing represents the general duties considered essential functions of the job and is not to be considered a detailed description of all the work requirements that may be inherent in the position.
- This position may interact with all departments within the organization, especially Customer Care and external vendors.
EDUCATION & EXPERIENCE REQUIREMENTS:
- High school diploma or general education degree
- Associate’s degree preferred
- 3+ years related experience
- This position requires no supervisory responsibilities.
SKILLS & QUALIFICATIONS REQUIREMENTS:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to individuals with disabilities to perform the essential functions.
- Advanced technical knowledge of Microsoft products required (Excel, Word, Outlook)
- Must be able to work in a fast-paced environment
- Must have strong organizational skills and attention to detail
- High degree of accuracy
- Manage multiple tasks independently
- Other skills necessary are accounting, data entry, general math, analytical, thoroughness, research, verbal/written communication
- Excellent problem resolution
- Excellent customer service skills
- Outside-the-box thinker
- General office environment. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Maintains a clean, neat, and orderly work area.
- Adheres to Department Specific Safety Guidelines.
- Standing, sitting, walking, bending, reaching, manual manipulation, and lifting up to 15 pounds.