Irvine, CA

July 2, 2020

Location: Irvine, CA

Department: Billing and Collections

Reports To:  Reimbursement Manager

FLSA Status: Non-Exempt

 

 

JOB SUMMARY:

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.

 

KEY CONTACTS:

  • 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

 

ENVIRONMENT/SAFETY/WORK ENVIRONMENT:

  • 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.

 

PHYSICAL DEMANDS:

  • Standing, sitting, walking, bending, reaching, manual manipulation, and lifting up to 15 pounds.