Collector: Revenue Cycle Epic

Our client operates within the healthcare revenue cycle management sector, addressing challenges related to insurance claims, patient billing, and payment collections. They manage interactions with insurance companies, government payors, and patients to ensure accurate and timely reimbursement, emphasizing compliance with managed care contracts, federal and state requirements, and effective use of patient accounting systems to optimize revenue collection.

About the Role

This position is responsible for managing accounts to secure payment for healthcare services. The role involves evaluating claims, initiating appeals for underpayments, and resolving billing issues with payors and patients. It contributes to the organization's financial health by maximizing reimbursement and maintaining compliance with billing policies and procedures.

Responsibilities

• Serve as the account representative handling insurance companies, government payors, and patient accounts for payment resolution.
• Complete assigned accounts within designated work queues.
• Evaluate claims using contract management tools to obtain maximum reimbursement.
• Initiate appeals for underpayments within required timelines.
• Manage payor and patient correspondence promptly.
• Escalate accounts needing appeals due to billing, coding, or payment discrepancies.
• Report new or unclear billing edits to supervisors.
• Maintain a strong understanding of revenue cycle processes and managed care contracts.
• Interpret Explanation of Benefits (EOB) and Electronic Remittance Advices (ERA) for payment accuracy.
• Understand hospital billing forms (UB04, HCFA 1500) and insurance payor processes.
• Use patient accounting systems effectively and document all actions.
• Accurately code insurance plan information.
• Establish payment arrangements for patients unable to pay in full.
• Review applicable cash rates, discounts, bankruptcy, and deceased patient accounts as applicable.
• Consistently meet productivity and quality standards.
• For Collector II: Demonstrate proficiency, assist in multiple areas, support special projects, problem-solve independently, assist with peer training, and maintain high performance without recent corrective actions.

Requirements

• Knowledge of revenue cycle processes from patient access through billing and collections.
• Familiarity with managed care contracts, current payor rates, and federal/state regulations.
• Ability to interpret EOBs and ERAs.
• Understanding of hospital billing forms and insurance payor types.
• Proficiency with patient accounting systems and insurance coding.
• Strong communication and documentation skills.
• For Collector II: Proven proficiency, multitasking across areas, problem-solving, training support, and sustained performance.