Sr. Managed Care Collector in Santa Fe Springs, CA at Pipeline Health

Date Posted: 11/10/2022

Job Snapshot

Job Description

Job Title: SR MANAGED CARE COLLECTOR

Job Summary:  Responsible for collecting on assigned accounts in a professional and timely manner. Work with Insurance companies and other payors to resolve accounts efficiently. Responsible for High Dollar and Sub-acute accounts. Have the ability to help reduce aging AR. Work with Manager on special projects. Assist Manager in the absence or Lead. Must be able to multi-task and have knowledge of contract language.

Reports To: Managed Care Manager, and or CBO Director

Essential Job Duties:  

•         Demonstrates competency in the quality of work and knowledge of the job pertinent to the functioning of the position of Sr Collector.

•         Follow up on High Dollar and Sub-Acute accounts within 30 days from billed date.

•         Follows up on all accounts after billing until payment is received.

•         Reviews and follows up on aged accounts with documentation in an efficient and thorough manner with accuracy.

•         Ensures appropriate phone calls/or website status towards resolution on each account.

•         Demonstrate the ability to trend Payer issues and share with co-workers.

•         Demonstrate the ability to create follow-up claim status spreadsheet for payors.

•         Complete and update all Payer spreadsheets accurately and timely.

•         Attend Payer conference calls timely.

•         Take notes on Payer’s conference calls.

•         Complete any action items pending from Payer’s conference calls

•         Produce ATB’s/Reports as needed

•         Ensures re-bills to payers as needed and change update to correct plan IDs.

•         Work closely with the clinical appeal nurse to ensure all appeals are follow-up within 30 days from sent date.

•         Meet with clinical appeal nurse monthly to exchange any new information

•         Prepares appeals on denials and underpayments as needed.

•         Mails follow-up letters to patients/ insurance companies as needed.

•         Consistently exercises sound judgment in arranging account settlement plans. 

•         Prepares accounts settlement options in a clear and persuasive manner.

•         Works accounts on work ques/reports provided, averaging a minimum of 35 per day.

•         Demonstrate the ability to reduce aging AR.

•         Attend payer and Vendor webinars as needed.

•         Handles all clients in a courteous and professional manner.

•         Learn contract expected payments calculations for underpayment appeals

•         Ensures contractual/discounts are applied to accounts as specified in each contract.

•         Refers an account to a biller and forwards a copy of the primary carrier’s EOB if a secondary insurance is applicable.

•         Follows up on all correspondence requiring action as needed.

•         Retrieves Patient records from the HBF system as needed.

•         Demonstrates the ability to recognize and deal with priorities to complete work in a timely manner.

•         Work with Manager and or Lead on special projects.

•         Assist Manager in the absence of Lead.

•         Performs all other duties and projects as assigned.

Behavioral Standards: 

•         Exhibits customer and service oriented behaviors in every day work interactions.

•         Demonstrates a courteous and respectful attitude to internal workforce and external customers.

•         Communicates accurately and appropriately.

•         Works well and efficiently under minimal supervision.

•         Handles difficult situations in a discreet and professional manner.

•         Is adaptable to changes in assignments and priorities.

Communication/Knowledge:

•         Provides accurate and timely written and verbal communication of information in a manner that is understood by all.  

•         Able to listen, understand, problem-solve, and carry-out duties to ensure the optimal outcome.

•         Able to use IT systems in an accurate and proficient manner.

Collaboration/Teamwork:

•         Contributes toward effective, positive working relationships with internal and external colleagues.

•         Demonstrates cooperation, flexibility, reliability, and dependability in all daily work activities and a willingness to collaborate with others for the good of the customer and the organization.

Education/Experience:

•         High school graduate or equivalent required

•         Prefer at least 2 to 3 years of current experience in an acute care hospital setting

•         Knowledge of contracts

•         Computer skills preferred 

ADA/Physical Demands:

•         To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed are representative of the knowledge, skill, and/or ability required.  Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant in order to be considered.

•         Required to stand; walk; sit; use hands to fingers, handle, or feel; reach with hands and arms; stoop, kneel, crouch, or crawl; talk and hear; and may taste and smell.  The employee is regularly required to lift, push and/or pull weights in excess of 10 pounds, with assistance. Visual abilities, auditory abilities, must be intact to perform duties.