Medical Collector

Schedule/Shift:
M-F 7-3:30 PST - can start as early as 6am PST after training but will need to work those hours to start
After first week or two: Start Time can be anytime between: 6am-9am PST

Job Overview:
The PFS Specialist's main role is to assist the collections team towards department goals of increasing cash collections and improving upon reimbursement rates. The PFS Specialist should have the ability to work any claim, regardless of aging, and must work with both commercial and government payers, and review EOB's.

Job Responsibilities:
1. Works with collections team to ensure daily productivity and quality standards are met, as well as assist with training and coaching to ensure all team members are operating at full potential
2. Creates notes on the patients account for auditing and actions taken per the Standard Operating Procedures or as outlined by the team manager
3. Works the total patient accounts outstanding A/R including credits and denials to reduce A/R aging buckets per the department's goals
4. Works hand in hand with the other team members to correct errors
5. Send corrected claims and appeals based on payer guidelines in a timely manner
6. Other projects as assigned

Education and Knowledge:
-High school diploma plus some college preferred
-Knowledge of CPT codes, medical terminology, insurance plans, ICD 10 codes
-Must have ability to adapt to a fast paced, dynamic environment
-Must understand different payer plans collections process, Xifin knowledge preferred

Technical Competencies (Skill, Abilities and Capabilities):
-Must have excellent computer skills
-Must understand the different payer plans and basic understanding of A/R
-Must have working knowledge of MS Excel

EXPERIENCE:
1-2 years' experience in working denials

Overview
-This is an insurance collections role through and through - want people who come from that background
-Need to be able to push back on insurances/handle appeals, work denials, etc.
-Will pass on people who come from the full cycle background - not what they want
-Most common denials - medical necessity or no auth
-Main payroll mix they are looking to fill - Medicare, Cigna, Humana and Med Advantage
-Touch 40 accounts per day - will be audited each month on amount and quality
-2 week training but ongoing with managers/directors

Experience:
-2+ years of Insurance collections exp
-Strong excel knowledge
-Ability to work appeals/denials
-Lab/Xifin a plus

3-5 Must Have Skills/Qualifications:
-2+ years of healthcare collections exp , excel exp, understanding of denials/appeals process
-Medicare experience
-Want people with a strict collections background, don't really want full cycle exp. want them to have experience doing only collections in some of their recent exp

Nice to Have Skills:
XIFIN, Exp working with large payor mix, Lab collections