Collector Governmental - FT - Days - Billing & Collections
Company: Doctor's Hospital at Renaissance
Posted on: April 30, 2021
POSITION SUMMARY: This position is responsible for activities
leading to the collection of accounts receivable that are
outstanding on the ATB, utilizing verbal and written communications
with insurers, providers, employers, and other payers. This
position requires being familiar with commercial, workers
compensation, and liability third party payer reimbursement, and is
accountable for getting those accounts collected. POSITION
- High school diploma/ GED is required
- Comprehensive knowledge of healthcare reimbursement
- Understands medical terminology
- Knowledge of Microsoft Office suite, working knowledge of Excel
- Excellent Customer Service
- Good written and verbal communication skills required.
- Must be able to multi-task
- Ability to read, write and speak English.
- Ability to communicate clearly and concisely with all levels of
- Previous healthcare experience (1-2 yrs.) is required, hospital
experience preferred. JOB KNOWLEDGE/EXPERIENCE:
- Minimum of 1-2 yrs. experience with medical collections,
managed care contract experience is preferred.
- Communicates clearly and concisely and is able to work
effectively with other employees, patients and external
- Provides excellent customer service by establishing and
maintaining long-term relationships with carrier reps.
- Demonstrates proficiency in Microsoft Office applications, be
able to type at least 35 WPM, and good working knowledge of Excel
- Able to perform basic mathematical calculations, balance and
reconcile figures, punctuate properly and spell correctly.
- Ability to use the internet to obtain claim status with TMHP,
FISS, MY Ability, and Third Party Payers.
- Requires working with minimal to moderate interruptions
- Promotes the facility mission, vision and values by effectively
communicating them to others. Considers mission, vision and values
in developing services, standards and practices
- Responsible for following up insurance accounts assigned on
AEOS System and or ATB reports
- Contacts insurance carrier for payment on assigned
- Follows-up on an average of 45 (225 weekly) accounts daily and
completes 100% of the assigned accounts by the end of each
- Adheres to Governmental Billing and Collection payer rules and
guidelines located in the Medicare/Medicaid manuals when contacting
- Proficient in accessing information from AX or Cerner
- Proficient in accessing the Medicare System-FISS, My Ability
for eligibility and claim status and the Medicaid System-TMHP to
obtain eligibility and claim status
- Proficient in attempting to update TPR segments as applicable
with Third Party Payers
- Proficient in determining when a 121 and or 131 Type of Bill is
required for Ancillary billing due to Medical necessity and or
Exhausted Benefits; also includes to ensure accounts are sitting
with appropriate payment, adjustment and patient balances
- Accurately utilizes AEOS system and or Email, when requesting
additional information from within internal or other departments
- Responsible to send AEOS RQs to Coding as needed for
clarification on diagnosis, CPT , HCPCS, or Modifier
- Reviews accounts to ensure the appropriate insurance plan is
set-up and the correct insurance adjustment was posted.
- Reads previous notes on the account and document new notes
using appropriate mnemonic in the notes tab which is also posted
- Familiar with managed care contract terms to determine
appropriate reimbursement of insurance carrier
- Ability to compare the payer reimbursement to the expected
payment in the computer and question any discrepancies with
insurance carrier when on the phone
- Ability to identify accounts that need insurance billing or
rebilling i.e., late charges, adjustments, patient related
- Contacts physician's office and request copies of documentation
- Request copies of medical records from HIM for any paper
records as needed
- Ability to obtain electronic records from the Cerner system as
- Contacts patient to ensure all requested information for
insurance company is provided. Ex. Pre-existing conditions, COB,
accident details, or claim forms, etc
- Daily follow up on faxes or messages to carriers within 24
hours, to ensure the fullest collection effort is
- Provide excellent customer service by responding to carriers or
patient calls within 24 hours and documents activity on the patient
- Assist other collectors in collecting a difficult account as
- Select correct adjustment codes and amounts on adjustment
letter to appropriately document reason for adjustment
- Notify management team of accounts that denied due to lack of
medical necessity, etc, to be assigned nurse auditor for review of
possible appeal; all accounts will have appropriate
- Complete adjustment forms appropriately with the correct loss
amounts and appropriate adjustment code with necessary backup,
variable data to be completed as applicable
- Responsible to complete all tasks assigned daily.
- Follow the Best Business Practice outlined in the DHR Billing
Specialist Priority Matrix-See attached.
- Adheres to the QA requirements process.
- Ensures patient confidentiality requirements are met in
accordance with HIPAA policies and procedures.
- Other duties as assigned. LINES OF REPSONSIBILITES:
- Supervisor Manager Director Chief Revenue Officer
Keywords: Doctor's Hospital at Renaissance, McAllen , Collector Governmental - FT - Days - Billing & Collections, Other , Mcallen, Texas
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