Robert Half • Costa Mesa, CA 92627
Job #2690228385
Description
We are looking for a Medical Collections Specialist to join our team in Costa Mesa, California. The role will focus on working with insurance companies, government payors, and patients for the resolution of payments and accounts. The successful candidate will be responsible for evaluating claims, initiating appeals for underpayments, reviewing and completing payor and patient correspondence, and documenting all actions taken in the appropriate systems.
Evaluate claims at the contract rate for proper pricing
Initiate the initial appeal for underpayments
Review and complete payor and patient correspondence in a timely manner
Escalate to the payor and patient accounts that need to be appealed due to improper billing, coding, and underpayments
Report new/unknown billing edits to the supervisor for review and resolution
Demonstrate a strong understanding of the Revenue Cycle processes, including patient access (authorizations & admissions) through patient financial services (billing & collections)
Exhibit thorough knowledge of managed care contracts, current payor rates, understanding of terms and conditions, as well as Federal and State requirements
Interpret Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs) to ensure proper payment
Understand hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms
Demonstrate 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
Accurately code insurance plan codes
Establish 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.
Requirements - Proficiency in customer service and maintaining high customer satisfaction levels
Ability to manage and maintain accurate documentation
Proficiency in Microsoft Excel
Experience in training team members or staff
Understanding of procedures and policy implementation related to collections
Experience in payment processing and cash activity management
Strong research and planning process skills
Ability to review and provide workstation support
Knowledge of medical coverage, pricing, and benefit functions
Experience in billing and collection processes
Skill in correspondence and claim administration
Ability to maintain high productivity levels
Willingness to travel as required for the role
Understanding of clinical trial operations and coding
Experience in managing authorizations.
Robert Half is the world's first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.
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All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit ~~~ for more information.
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