Self-pay collector position responsible for inbound and outbound calls to collect on patient receivables for complete and accurate account resolution. Must be able to work efficiently and in a positive manner in a high-stress, high call volume atmosphere.
- Ensures all claims are accurately transmitted daily within the PFS targets and goals.
- Provides feedback to management regarding any issues or repetitive errors that may be encountered during claim review and submission.
- Completes follow-up of claims on a timely basis according to the productivity guidelines for account follow-up goals.
- Reviews system-generated worklist, reports and/or aged trial balances to resolve accounts that have not been paid in the appropriate time frame, based on specific third party payor contracts and guidelines.
- Contacts assigned payer representatives to determine when payment will be made and if other information is required to adjudicate a claim.
- Reviews payment denials and discrepancies identified through Explanation of Benefits, Remittance Advice or payer correspondence and takes appropriate actions to correct these accounts.
- Documents account activities in an accurate and timely manner in accordance with PFS quality standards.
- Applies a high level of knowledge of respective insurance billing regulations and guidelines.
- Researches these guidelines when required on payer websites where available.
- Ensures compliance with all state and federal billing regulations and reports suspected compliance issues to their respective Leads/Supervisors/Managers.
- Conducts inquiries via telephone, mail, and fax or electronically through payer websites or e-mail for follow-up of unresolved accounts. Contacts patient for additional information in order to ensure claims are processed and paid.
- Works with various departments throughout Lake Regional Health System in obtaining additional information for the billing and follow-up process.
- Works with management and PFS staff to improve processes, increase accuracy, create efficiencies and achieve the overall goals of the department.
- Maintains proficiency and levels of knowledge with all systems required for task completion.
- Respects the rights and dignity of all patients.
- Provides and maintains patient privacy at all times.
- Is compliant with HIPAA guidelines and privacy practices, patient confidentiality, and patient rights.
Functions as a team member to organize and prioritize responsibilities to complete daily work requirements. Demonstrates a positive, supportive, respectful and helpful attitude in interactions with all department customers (patients, physicians, visitors, and other healthcare team members. Offers and acts on constructive feedback. Maintains a calm, professional manner. Maintains high attention to detail by reviewing all work for completeness and accuracy. Completes account-related tasks to meet department accuracy standards for error-free work.
Must have the following skills:
Excellent Customer Service
Excellent verbal & written communication skills
Proficient in hospital & physician billing
Proficient in math
High school diploma or GED required.
Previous medical billing experience preferred.
Must be organized, customer-focused and have the ability to multi-task in a fast-paced environment.
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