Duties :
- Initiates calls or online web contact to payors or guarantors to verify receipt of claims / statements and collect on outstanding accounts receivables as specified by current collection policies and procedures
- Documents follow-up activities, conversations with payors / guarantors, information obtained via the web contact, and any correspondence in the account notes.
- Ensures payments received by third party payors are correct and the correct contractual discounts / allowances have been applied according to the contract matrix or government reimbursement rates.
- Ensures that all accounts associated with that guarantor and payor relationship are resolved.
- Analyzes and assesses accounts for outstanding balances and makes prudent decisions on appropriate actions needed to resolve the balance.
- Identifies and reports inaccurate reimbursement and contractual trends to Sr. Reps, Team Lead, or Manager.
- Refers problem accounts to Sr. Rep, Team Lead or Manager prior to accounts becoming 60 days old.
- Documents the issues in detail and refers to Sr. Rep, Team Lead or Manager with a recommendation of action needed. Provides continual
- follow-up.
- Assists with special projects to ensure that collection, workqueue, and departmental goals are met.
- Must have hospital billing collections.
- General government payer collections experience.
- Should be well spoken and well versed in the Insurance / Collections / Appeals process.
- Has longevity in a previous position and recent Collections experience.
- Requiring Hospital Insurance Collections experience (Minimum of 2 years).
- Government Hospital Collections is a PLUS (Traditional Medicaid, Managed Medicaid Plans).
- Experience in larger facilities and have a track record of being able to adapt to both quality and productivity standards
- General knowledge of government, commercial and managed care reimbursement methodologies and understanding of all federal, state, and local legal aspects of collection regulations.
- The knowledge of how managed care plans work and the requirements for insurance coverage and benefits.
- Ability to communicate effectively both oral and written, good interpersonal skills; decision-making skills; professional courtesy;
the ability to operate a PC and general office equipment.
- Account Representatives must have a strong math aptitude in order to be able to verify the appropriate reimbursement based upon the contract terms, benefits and / or government regulations.
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