Collector III: Revenue Cycle Epic

Primary Duties and Responsibilities* The Collector serves as the account representative for Hoag in working with insurance companies, government payors, and/or patients for resolution of payments and accounts resolution.

• Completes assigned accounts within assigned work queues.
• Obtains the maximum amount of reimbursement by evaluating claims at the contract rate with the use of the contract management tool for proper pricing (Examples: APC, DRG, APRDRG).
• Reviews and initiates the initial appeal for underpayments observing all timely requirements to secure reimbursement due to Hoag.
• Reviews and completes payor and/or patient correspondence in a timely manner.
• Escalates to the payor and/or patient accounts that need to be appealed due to improper billing, coding and/or underpayments.
• Reports new/unknown billing edits to direct supervisor for review and resolution.
• Has a strong understanding of the Revenue Cycle processes, from Patient Access (authorizations \& admissions) through Patient Financial Services (billing \& collections), including procedures and policies.
• Has thorough knowledge of managed care contracts, current payor rates, understanding of terms and conditions, as well as Federal and State requirements.
• Interprets Explanation of Benefits (EOBs) and Electronic Admittance Advices (ERAs) to ensure proper payment as well as assist and educate patients and colleagues with understanding of benefit plans.
• Understands hospital billing form requirements (UB04) and is familiar with the HCFA 1500 forms.
• Possesses knowledge of HMO, POS, PPO, EPO, IPA, Medicare Advantage, Covered California (Exchange), capitation, commercial and government payors (i.e. Medicare, Medi-Cal, TriCare, etc) and how these payors process claims.
• Demonstrates knowledge of and effectively uses patient accounting systems.
• Documents all calls and actions taken in the appropriate systems.
• Accurately codes insurance plan codes.
• Establishes a payment arrangement when patients are unable to pay in full at the time payment is due.
• May review for applicable cash rates, special rates, applicable professional and employee discounts.
• May process bankruptcy and deceased patient accounts.
• Performs other duties as assigned.
• Consistently meets individual productivity and quality assurance standards.
• Performs other duties as assigned.
• Demonstrates proficiency in the functions of a Collector I \& II.
• Strong knowledge of carrier’s (Federal/State/Private) regulations and guidelines.
• Assists peers and Supervisor/Manager with escalated situations.
• Actively participates in training and onboarding of new team members.
• Identifies ongoing training and recommendations for existing staff.
• Identifies and makes recommendations for development of processes or protocol changes.
• Exceeds individual productivity and quality assurance standards for at least 12 consecutive months.
• No corrective action within the last 12 months.

Education and Experience

• High school diploma or equivalent required.
• Five years' experience in a hospital/medical and or/related field.
• Working knowledge Epic Resolute, Epic Cer, and Epic CPOE and reporting.
• Working knowledge of MS Excel.
• Highly detail-oriented with proven ability to organize and prioritize assignments.

License Required

N/A

License Preferred

N/A

Certifications Required

N/A

Certifications Preferred

N/A