Preferred
3-5 years of experience in a hospital business environment performing billing and / or collections. No certification requirement however someone with a strong background in collection and patient accounting (medical billing). EPIC back-end experience is a must.
Job Summary :
The PFS Collection Specialist is responsible for all aspects reviewing payer contracts, claims and performing third party collection activity for hospital services.
Qualifications :
- Required Education :
- High school diploma or equivalent education.
- Minimum Experience : One year of experience in a Revenue Cycle area within the Alameda Health System; OR the equivalent of two years’ experience, performing medical billing / collections or medical accounts receivable functions in a healthcare insurance related environment.
Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.
Knowledge, Skills & Abilities :
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Good written and verbal communication skills.Intermediate computer skills including thorough understanding of the EHR system, Microsoft Office (Word, Outlook, Excel, PowerPoint).Intermediate knowledge of UB-04 and Explanation of Benefits (EOB) interpretation.Intermediate knowledge of CPT and ICD-10 codes.Intermediate knowledge of insurance claims and insurance terminology.Act in an appropriate and professional manner as defined by the company’s Standards of Behavior, Policy and Procedures, and Scope of Services.Role model AHS Standards of Behavior.Current office administrative practices and procedures.Correct business English, including spelling, grammar and punctuation.Use independent judgment and initiative within established policies and procedures.Establish and maintain effective working relationships with a variety of individuals from various socioeconomic, ethnic and cultural backgrounds.Should have a good understanding of payer contract language, and how to apply language to reimbursements.Excellent communication skills, both written and verbal.Physical Requirements and Work Environment :
The physical demands and work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.Activity : Sit : Continuously (more than 2 / 3 of the work shift)Activity : Stand : Occasionally (up to 1 / 3 of the work shift)Activity : Walk : Occasionally (up to 1 / 3 of the work shift)Motion : Bend / Twist : Up to 1 / 3 of timeMotion : Carry / Lift : Up to 1 / 3 of timeMotion : Reach : Up to 1 / 3 of timeMotion : Squat : Up to 1 / 3 of timeUse of Hands (Left / Right) : General Motor FunctionUse of Hands (Left / Right) : Precise Motor Function (Or Fine Manipulation)Use of Hands : Repetitive Motion : 1 / 3 or more of timeWeight Lifted / Force Exerted : Up to 10 lbs : Up to 1 / 3 of timeWork Environment : Special visual or auditory requirements including working with a computer terminal.Work Environment : Tasks involve no exposure to blood, body fluids, or tissues.FLSA Status & Representation :
FLSA Status : NonexemptRepresentation : SEIU 1021Job Responsibilities :
Responsible for all aspects of follow up and collections on insurance balances, including making telephone calls, accessing payer websites. Identify issues or trending and provide suggestions for resolution. Accurately and thoroughly documents the pertinent collection activity performed. Review the account information and necessary system applications to determine the next appropriate work activity. Verify claims adjudication utilizing appropriate resources and applications. Initiate telephone or letter contact to patients to obtain additional information as needed. Perform appropriate follow-up functions, including manual re-submissions as well as electronic attachments to payers. Manage and maintain desk inventory, complete reports, and resolve high priority and aged inventory.Participate and attend meetings, training seminars and in-services to develop job knowledge. Participate in the monthly, quarterly and annual performance evaluation process with Supervisor. Respond timely to emails and telephone messages as appropriate. Communicate issues to management, including payer, system or escalated account issues.Maintains information or operational records; screens reports for completeness and mathematical accuracy; list, abstracts, or summarizes data; compiles routine report from a variety of sources.May, as a secondary responsibility, interpret abstracts, orders, notes, invoices, permits, licenses, etc.; computes and receives fees when the amount is not in question or is readily obtainable from fixed schedules; posts data; and prepares reports in accordance with pre-determined forms and procedures.Prepares documents for collection of revenues from third party payer programs; checks and verifies charge rates for services; reconciles account balances and verifies payments.Reviews billing documents to assure program compliance for Medicare, Medi-Cal, Mental Health, and insurance programs; assures that all appropriate medical documentation is submitted timely.Other duties as assigned.