Medical Collector

Additional Comp Info

Salary based on experience.

Overview

Planned Parenthood of Orange and San Bernardino Counties has a full-time opportunity for a Revenue Medical Collector in Anaheim, CA.

 

The Revenue Recovery Analyst identifies, collects, and determines root causes of underpaid claims by auditing payor performance and analyzing actual payments of payors to ensure contract compliance, which is operationally critical and sensitive in nature. The Revenue Recovery Analyst will support the RCM collection team with training and escalated claim follow-up. The Revenue Recovery Analyst performs payment variance deep dive and review activities related to the incorrect processing of claims across PPOSBC. This position will focus on the resubmission, reprocessing, and correcting of denied or rejected/exhausted insurance claims (2nd Level) as well as all high-volume facilities, top payors, and high-level, complex claim issues.

 

At PPOSBC, we understand the importance of a well-rounded benefits program and are dedicated to providing you with unique benefits that meet the needs of you and your family. We are proud to offer a range of plans that help protect you in the case of illness or injury including:

• A competitive benefits package including medical, dental, and vision coverage for you and eligible dependents, life insurance, and long term disability.
• Benefits coverage starts after one full month of employment!
• Generous vacation, sick, and holiday benefits!
• Generous 401(k) matching contributions and more!
• To view our detailed benefits guide, please visit our career site at www.pposbccareers.org

Qualifications

Licensure and/or Certification Requirements:

• Coding certificate is a plus.

Minimum Education:

• Associate's Degree required in related field.
• Bachelor’s Degree preferred or equivalent experience in related field.

 

Minimum Work Experience:

• A minimum of 5 years of experience as a medical biller/claims follow-up specialist or collections specialist in an outpatient medical setting (non-hospital) in primary care (required), family planning, ob-gyn, and related surgeries.
• Advanced knowledge of medical terminology and common industry abbreviations, anatomy and physiology, pharmacology, and pathophysiology.
• Knowledge of payor guidelines, industry billing, and coding standards, and Medi-Cal denials reason codes.
• Computer database management (electronic practice management system). EclinicalWorks/NextGen experience preferred.
• A minimum of 5 years of experience with insurance billing, coding, and reimbursement procedures.
• A minimum of 5 years of experience with HIPAA 5010 transaction standards.
• A minimum of 5 years of experience claims follow-up/appeals and health plan Accounts Receivable management for specific payors.

 

Other Requirements:

• Ability to successfully communicate with payors, including insurance companies, health plans, and medical groups, regarding unpaid claims. Knowledge of CPT4/HCPCS and ICD10 coding and billing guidelines.
• Advanced knowledge of Medi-Cal Managed Care, Commercial Payors, Medi-Cal, FPACT, & PE.
• Advanced knowledge of health care and Medi-Cal denial reasons, denials codes and descriptions, and standard denial resolution practices.
• Ability to judgment independently as to compare actual reimbursement to expected reimbursement, reviewing managed care contract terms, claims billing and clinical information to effectively reconcile underpaid accounts and maintain documentation to support this activity.
• Expert knowledge of health care reimbursement and contracting and the use of deductive reasoning, negotiating skills, and collaborative skills to uncover and recover payment discrepancies in a complex system and complex payor environment.
• Strong verbal and written communication skills are essential.
• Ability to demonstrate mature judgment, initiative, and critical thinking.
• Strong follow-up skills and time management with internal and customer stakeholders.
• Ability to maintain confidentiality.
• Accuracy and attention to detail is essential.
• Availability to work flexible hours, including weekends.

 

Agency Standard Requirements:

• Strong commitment to quality healthcare and excellent customer service is required.
• Must thrive in a fast-paced, rigorous environment with changing priorities.
• Ability to meet deadlines and work under pressure.
• Must demonstrate high-level computer skills, including Microsoft Word, Excel, and O