Collections Specialist - Medical Claims

Software Guidance & Assistance, Inc., (SGA), is searching for a

Collection Specialist for a

Contract

assignment with one of our premier

Healthcare

clients in

San Leandro, CA.

The PFS Collection Specialist is responsible for all aspects reviewing payer contracts, claims and performing third party collection activity for hospital services.

Responsible for all aspects of follow up and collections on insurance balances, including making telephone calls, accessing payer websites. 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. 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.

list, abstracts, or summarizes data; posts data; Prepares documents for collection of revenues from third party payer programs; 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.

High school diploma or equivalent education.

EPIC back-end experience

OR the equivalent of two years experience, performing medical billing / collections or medical accounts receivable functions in a healthcare insurance related environment.

Intermediate computer skills including thorough understanding of the EHR system, Microsoft Office (Word, Outlook, Excel, PowerPoint).

Intermediate knowledge of insurance claims and insurance terminology.

Act in an appropriate and professional manner as defined by the companys Standards of Behavior, Policy and Procedures, and Scope of Services.

Current office administrative practices and procedures.

Correct business English, including spelling, grammar and punctuation.

Use independent judgment and initiative within established policies and procedures.

Should have a good understanding of payer contract language, and how to apply language to reimbursements.

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).

We are a women-owned business. Our mission : to solve big IT problems with a more personal, boutique approach. Youll join a diverse team built on these core values : customer service, employee development, and quality and integrity in everything we do. SGA is an Equal Opportunity Employer and does not discriminate on the basis of Race, Color, Sex, Sexual Orientation, Gender Identity, Religion, National Origin, Disability, Veteran Status, Age, Marital Status, Pregnancy, Genetic Information, or Other Legally Protected Status. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, and our services, programs, and activities. Please visit our company

EEO page

to request an accommodation or assistance regarding our policy.