Senior Collections Representative

A Senior Collections Representative Biller/Collector is responsible for both billing and collections, gathering and securing all information needed for billing, follow-up, and payment of accounts in accordance with the specific payer guidelines, policies, procedures, and compliance regulations.  A Biller/Collector is responsible for reviewing, correcting, and completing billings to ensure complete and accurate billing of Medicare, Medi-cal, Managed Medicare/Medi-cal, and/or Other Government payers.  A Biller/Collector calculates expected reimbursement to verify expected payments versus actual payments received.  A Biller/Collector files disputes with payers for denials and/or underpayments. A Biller/Collector is accountable and responsible for accurate billing and reconciling accounts to closure.

Senior Collections Representative Biller/Collector utilizes multiple databases and applications to analyze and take appropriate action on information or documents received.  Applications and Databases consist of:  EPIC, Hospital Rates, CIRIUS, RevCyclePro, Imaging, DDE, and various payer websites. Frequent contact with Patient Financial Services staff, departments, and management, as well as patients, billing, professional fee and collection services vendors.
 

A Senior Collections Representative Biller/Collector is responsible for both billing and collections, gathering and securing all information needed for billing, follow-up, and payment of accounts in accordance with the specific payer guidelines, policies, procedures, and compliance regulations.  A Biller/Collector is responsible for reviewing, correcting, and completing billings to ensure complete and accurate billing of Medicare, Medi-cal, Managed Medicare/Medi-cal, and/or Other Government payers.  A Biller/Collector calculates expected reimbursement to verify expected payments versus actual payments received.  A Biller/Collector files disputes with payers for denials and/or underpayments. A Biller/Collector is accountable and responsible for accurate billing and reconciling accounts to closure.

Senior Collections Representative Biller/Collector utilizes multiple databases and applications to analyze and take appropriate action on information or documents received.  Applications and Databases consist of:  EPIC, Hospital Rates, CIRIUS, RevCyclePro, Imaging, DDE, and various payer websites. Frequent contact with Patient Financial Services staff, departments, and management, as well as patients, billing, professional fee and collection services vendors.

Required Qualifications 

• Four or more years of experience working in a hospital billing office environment
• High school diploma or GED certificate.
• Must demonstrate an in-depth understanding of all aspects of billing.  For internal hires, one must be greater than that of an Office Assistant III and a Senior Collections Rep I
• Knowledge of contracts, insurance billing requirements, UB04 claim forms, Medicare, Medi-Cal and compliance program regulations.
• Good analytical and organizational skills, interpersonal, verbal, and written communication skills.
• Knowledge of computer operation, keyboard functions, calculator, copier, and fax machine operation.
• Adequate keyboard skills.
• Proactive and assertive account resolution skills. 
• Must be a motivated individual with a positive and exceptional work ethic.
• Ability to follow directions and written procedures.
• Ability to balance assertiveness with compassion for the patient and others.
• Must have a thorough understanding of CPT, ICD, DRG, and HCPC codes
• Must have a thorough understanding of stop losses, per diems, carve-outs, and other contract terms and conditions.
• Computer software skills (i.e. Microsoft Applications and E-mail, etc.).
• The ability to work in Emeryville a min. of one day a week or more.

Preferred Qualifications 

• Medical terminology experience. 
• ICD, CPT4, HCPCS, DRG coding experience.
• Understanding of HIPAA rules and regulations