COORD, CREDIT/COLLECTIONS

About the role

The Credit/Collection Coordinator monitors and maintains Managed Care Accounts Receivables, including timely payments and a denial tracking system reported to the Manager monthly. This role plays a key part in the payment review team by reviewing claims and payment information to identify potential underpayments and trends, enabling accurate pursuit of lost revenue.

Responsibilities

• Demonstrates ability to perform all specified functions within the Credit/Collection department and trains new employees while improving the skill level of existing staff.
• Identifies potential underpayment trends by comparing managed care contracts to actual reimbursement information.
• Assists with inpatient and outpatient coverage.
• Identifies areas of improvement for staff and develops training programs to enhance qualifications.
• Monitors follow-up activity on open accounts receivable for Outpatient Commercial/HMO, Comp, and No Fault.
• Monitors and researches Managed Care payment discrepancies, denials, and outstanding issues.
• Organizes monthly Managed Care meetings with representatives.
• Maintains open communication with third-party payers regarding contract issues.
• Reports underpayments and trends to management and the payment review team for pursuit and collection.
• Monitors and maintains Financial Aid Charity Care applications for Inpatient/Outpatient services, including application review and written notification within mandated legislation guidelines.
• Provides analyses to the Manager and educates other departments on guidelines.
• Advises and maintains changes mandated by NYS.
• Collaborates with the Manager on special projects, such as month-end bad debt, Charity Care statistics, and outpatient exception reports.
• Submits weekly/monthly electronic files and qualifies accounts for Collection/Bad Debt status.
• Maintains patient/commercial/HMO overpayments and processes refunds according to departmental policy.
• Uses high-volume reports to review historical payment information and determine reimbursement accuracy.
• Performs other related duties as assigned, including assisting with special projects (e.g., Medipac) and A/R rebills.
• Serves as a brand ambassador by upholding the WMCHealth Mission, Vision, and CARE values, promoting excellence in the patient experience during every encounter.

Requirements

• 3-5 years’ experience in healthcare operations and data.
• College preferred; High School Diploma or equivalent required.
• Excellent organizational abilities.
• Solid knowledge of all MS Office products.
• Strong analytical, oral, and written communication skills.
• Ability to analyze and problem-solve.
• Excellent interpersonal and customer service skills.

If applicable, the individual may reasonably anticipate coming into contact with human blood and other potentially infectious materials. Universal precautions, personal protective equipment, and adherence to infection control policies are required.