Health Insurance Claims Collections Agent - 3-Month Contract (53185)

HEALTH INSURANCE CLAIMS COLLECTIONS AGENT

DURATION: 3-month contract (W2)

LOCATION: Pasadena, CA 91103

JOB NUMBER: 53185

CLIENT: One of the country's largest health care and health plan providers

DEPARTMENT: Patient Business Services

JOB DESCRIPTION:

This person will be performing Commercial Payor collections on insurance claims for professional and hospital services.

ESSENTIAL FUNCTIONS:

- Determine appropriate collection action by processing accounts in assigned work queues (eg, Company Work Queues, collector assignment report, aging reports, etc.)
- Responsible for follow-up and collection of accounts, including, but not limited to: inpatient, outpatient, emergency room, and pharmacy charges for all in- and out-of-network services, etc. by various means (systems, reports, etc.)
- Make recommendations as well as make decisions to refer accounts to appropriate line of business for billing/rebilling and/or outside collection agencies at any stage of the internal collection process
- Review accounts to ensure compliance with applicable local, state, and/or federal law and regulations, including organization policies and procedures
- Correspond with interested parties to resolve receivables via in-coming and out-going telephone, fax, mail, e-mail, telegram, and/or legal correspondence for accounts
- Responsible for gathering information, making recommendations related to adjustments of uncollectible balances and completing accounts appropriately
- Identify accounts which require refunds, calculate refund amounts, and refer accounts to appropriate support staff
- Respond to in-coming correspondence and telephone inquiries from patients, guarantors, third parties, attorneys, and other facilities or departments, etc. regarding accounts
- Responsible for initiating out-bound collection calls and handling in-bound call volumes within the standard(s) established by the department
- Achieve individual production and quality assurance performance within established expectations and standards
- Comply with legal and ethical requirements to protect patient, employee, and health plan confidentiality
- Identify and communicate ways of improving department processes, procedures, and customer relations by participating in Unit Based Teams and other Labor Management Partnership processes
- Interpret benefits, exclusions, and accurate reimbursement levels of primary and secondary insurance coverage
- Responsible for electronic billing/paper billing and interface between billing facilities and external entities
- Utilize documentation (eg, settlement draft, settlement release, awards issued by the court) to ensure maximum case settlement and take appropriate action for the following: posting adjustments, posting denials, processing appeals, changing financial classes, processing revenue reversals, write-off, rebilling/secondary billing, etc.
- Assist with preparation of cases for litigation by collecting supporting documentation

BASIC QUALIFICATIONS:

- Minimum 2 years' experience as a collector, biller, or customer service representative in a related health care patient accounting field within the last 4 years
- High school diploma or GED
- Basic minimum required experience/certifications OR successful completion of the PFS Career Ladder curriculum that is mapped to that position
- Ability to demonstrate knowledge of the Fair Debt Collection Practices Act and NAIC Guidelines; local, state, and/or federal Commercial laws and regulations; billing requirements, to include, but not limited to: ICD-9, CPT, and DRG codes, and fee schedule allowances and reductions; medical terminology and calculations necessary for account management
- Ability to demonstrate knowledge of line of business specific billing and collection rules, regulations and other pertinent payer specific requirements
- Demonstrated ability to work with patient accounting and computerized collection systems and use Windows operating system and Microsoft Office Applications (WORD, EXCEL, etc.)
- Demonstrated ability to utilize and apply active listening, communication, and persuasion skills, as well as the principles and processes needed to provide customer service

PREFERRED QUALIFICATIONS:

- AA degree in business or certification in insurance billing or collections issued by an accredited learning institution
- Multilingual
- Collector with experience in collecting from non-contracted commercial payors
- Epic system knowledge
- ePremis/Relay Health system knowledge
- Grounded understanding in Health and Safety laws