Collector, Management Services Organization/Centralized Billing Office - CBO - Full Time 8 Hour Days (Non-Exempt) (Non-Union)
About the role
The Collector Appeal Specialist and Professional Billing Refund Collector positions at USC Care Medical Group are responsible for various aspects of medical billing and collections. These roles involve accurately processing claims, ensuring timely filing, conducting quality control checks, initiating appeals, and managing credit balances.
Responsibilities
- Analyzes and determines billing procedures based on financial classes and types of financial providers.
- Contacts departments to obtain required information for processing claims.
- Edits charges on claim forms and recomputes total amounts due.
- Reviews sensitive diagnosis information to maintain patient confidentiality.
- Communicates identified billing issues and trends to supervisors and managers.
- Utilizes various billing systems and insurance directories to solve billing issues.
- Follows up on accounts for all payors, including Medicare, Medi-Cal, commercial, guarantor, and other contracted payors.
- Manages and processes assigned computerized or manual worklists to achieve collection standards and quality measures.
- Applies knowledge of contractual terms and applies proficiency in understanding and applying these terms.
- Documents claim details, updates case/payer data, and documents reasons for updates.
- Applies knowledge of Cerner, AIDX/GE and other systems to solve billing issues.
- Applies knowledge of various payor websites.
- Applies knowledge of managed care contracts (PPO, HMO, EPO, POS, Medi-Cal, Medicare, etc.).
- Applies knowledge of CPT, ICD-10-CM, HCPCS, Insurance Directories and other insurance books.
- Applies knowledge of GECB, Cerner, MARS Refunds App and daily ETM views to review and resolve credit balances.
- Applies knowledge of computing environments and user support experience with servers, operating systems, workstations, networks, LANs and network software.
Requirements
Must have high school diploma or equivalent. Experience with medical services collections for any combination of payors (Medicare, Medi-Cal/Caid, HMO, PPO, Commercial, and Private Pay) is preferred. Excellent communication skills, both written and oral, are essential. Expert skill-level in specialty area is required. Experience in computing environments and user support experience with servers, operating systems, workstations, networks, LANs and network software is preferred.
Qualifications
- High school diploma or equivalent.
- Experience with medical services collections for any combination of payors (Medicare, Medi-Cal/Caid, HMO, PPO, Commercial, and Private Pay).
- Excellent communication skills both written and oral.
- Expert skill-level in specialty area.
- Experience in computing environments.
- User support experience with servers, operating systems, workstations, networks, LANs and network software.
Skills
- Knowledge of CPT, ICD-10-CM, HCPCS, Insurance Directories and other insurance books.
- Knowledge of Cerner, AIDX/GE and other systems.
- Knowledge of various payor websites.
- Knowledge of managed care contracts (PPO, HMO, EPO, POS, Medi-Cal, Medicare, etc.).
- Knowledge of computing environments and user support experience with servers, operating systems, workstations, networks, LANs and network software.
Benefits
Not specified.
Pay
Not specified.
Schedule
Not specified.