Collector - Full Time Days

JOB SUMMARY:

Under general supervision, the Collector is responsible for managing assigned patient accounts from the point of billing through final resolution. This includes ensuring timely follow-up, payment collection, and appropriate referral to external agencies when necessary. The Collector serves as a key liaison between the Business Office and both internal departments and external customers, maintaining a high level of professionalism and customer service at all times.

EXPERIENCE/QUALIFICATIONS:

• Minimum of 1 year of demonstrated experience in hospital collections, with exposure to one or more of the following payer types: Commercial Insurance, Workers’ Compensation, Managed Care, Managed Care Medicare, or Managed Care Medi-Cal.
• Ability to interpret payer contracts and process contractual adjustments
• In-depth knowledge of UB04 requirements and medical billing processes
• Strong analytical skills and proven proficiency in Microsoft Office, Word, especially Excel and spreadsheets
• Understanding of collection techniques and laws
• Familiarity with medical terminology, Revenue codes, CPT codes, HCPCS codes, ICD-10 Diagnosis and Procedure codes, Health Networks, IPAs, HMOs, PPOs, PCPs, Workers Comp., and contract affiliations
• Excellent verbal and written communication skills
• Exceptional organizational skills, with the ability to meet deadlines, work independently or as part of a team, and prioritize tasks effectively
• Knowledge of Medicare’s Common Working File (CWF), Medi-Cal website, Internet, payer websites and electronic billing systems.

EDUCATION:

• High school diploma or equivalent required

LICENSURES/CERTIFICATION:

• Must successfully complete and maintain LA City Fire Card certification at the time of hire or within the first 30 days of employment

MUST HAVES:

• All required licensures, certifications, mandatory education, along with annual occupational health screenings must be completed prior to the expiration date or by the end of the month in which they are due. Reference the Educational Requirements: Must Haves, Mandatory and Unit Based policy (in electronic policy management system) for the specific requirements for this position.

DUTIES AND RESPONSIBILITIES (These are the essential job functions for this position. The essential functions of this job include but may not be limited to those listed in this job description. Employees hired for this position must be able to perform the essential function of this job without imposing significant risk of substantial harm to the health or safety of themselves or others):

• Manage assigned accounts from the point of billing until the account is paid or referred to an outside agency.
• Comprehend and follow internal and external policies and procedures.
• Present a professional image of the Business Office at all times.
• Diligently follow up on claims and document accounts to ensure timely resolution.
• Conduct timely account reviews to identify outstanding balances and credit balances.
• Adjust accounts accordingly as per contractual agreements, LOAs, billing guidelines etc. following internal policies and procedures.
• Provide detailed write off report for supervisor review and approval.
• Write off supervisory approved accounts according to internal policies and procedures
• Submit documentation to payers as needed, but not limited to initial bills, corrected bills, rebills, stop-loss bills, PDRs, appeals, medical records, invoices, refund request, overpayment, EOBs, etc. according to internal and external policies and procedures.
• Initiate and maintain verbal and written communication with payers to resolve reimbursement discrepancies of outstanding claim balances and credits.
• Communicate, verbally and in writing, with payers, providers, patients, and internal departments to gather necessary information to resolve payment issues.
• Accurately maintain individual procedure manuals for specific areas/payers of responsibility.
• Identify, report and participate in any workflow, billing, denials, write-off and collection issues with Management and Administration according to internal and external policies and procedures.
• Identify, report and process unidentified accounts/payments, credit balances, overpayments, refund requests with Management and Administration according to internal and external policies and procedures.
• Interpret Letter of Agreements, and payer contracts related to, but not limited to reimbursement, collection and billing requirements.

Attend and participate in workgroups, and team meetings as required.

• Participate in payer conference call discussions and provide payers with necessary information needed, verbal or written, of outstanding claim balances and credits.
• Assists with managed care contract feedback regarding contract interpretation concerns.
• Performs other duties as assigned.

The following job accountabilities are not unique to this particular job but are common to all jobs at VPH:

Complies with VPH policies and procedures on customer satisfaction and service excellence. Demonstrates professionalism and cultural sensitivity in coordinating activities and communicating with all customers, peers, and the community at large. Conducts self in a professional, respectful and courteous manner during all interactions. Works effectively and collaboratively with others toward common goals.

Communicates accurately, honestly, supportively and in a timely manner with department and interdepartmental team members. Demonstrates effective business writing and oral communication skills, handwriting is clear and legible.

Participates in operational aspects of the department, and maintains/participates in performance improvement activities within the department.

Participates in all departmental specific training, Environment of Care (injury/illness prevention, fire/life safety, hazardous materials, emergency preparedness, utilities management, medical equipment management, safety and security management), infection control (standard precautions, TB Exposure Control Plan, Bloodborne Pathogen Exposure Control Plan).

Demonstrates knowledge of and follows safety practices. Understands the importance of safety, including patient safety in the work place. Maintains a safe environment for self and others.

Actively participates in the Patient Safety Program, including event reporting. Identifies sentinel events/near misses and responds per defined organization processes. Participates in education activities and process implementation. Demonstrates advocacy for the patient/customer and appropriately acknowledges patients, customers and visitors.

The above statements reflect the essential functions considered necessary to describe the principle content of the job. They are not intended to be a complete statement of all work requirements or duties that may be inherent in the job.

WORK ENVIRONMENT:

• Primarily an inside building/office environment, well lighted and ventilated, which may consist of multiple treatment and/or work sites.
• Fast and continuous work pace with variable workload.
• Frequent contact with staff and public under a variety of circumstances. Requires ability to communicate clearly (in English) verbally and in writing for effective communication with other staff members, physicians, vendors, community members, patients and patient families, employees and applicants of all socio-economic levels from a diverse cultural and ethnic population.
• Subject to many interruptions from multiple calls and inquiries and potentially emotional situations involving accidents, injuries, illness and/or death.
• Handles emergency/crisis situations in accordance with Hospital policy.
• Answers phones or pages; may carry a beeper/pager, and/or use a two-way radio.
• Occasional travel may be required.
• Potential risk of exposure to hazards from chemicals (toxic and non-toxic), flammable materials, gas or electrical or radiant energy or equipment with/without moving parts.