Medical Collector I

The Medical Collector I is a full-time position responsible for managing denials and collecting outstanding account receivables securing payment of denied claims for Medical, Dental, Optometry, Behavioral Health, OB-GYN, and Podiatry, claims. This is a challenging and rewarding position that requires strong communication skills, attention to detail, and the ability to work in a fast-paced environment. This position reports to the Billing Manager, in some cases, the focus may be on either coding or billing but must be cross trained in both.

Benefits:

• Free Medical, Dental & Vision
• 13 Paid Holidays PTO
• 403 (B) retirement match
• Life Insurance, EAP
• Tuition Reimbursement
• Flexible Spending Account
• Continued workforce development & training
• Succession plans & growth within

Qualifications/Licensure: 

Education, Experience, & Knowledge

• Three (3) years of experience with revenue cycle operations management with excellent presentation and writing skills. 
• Advanced skills in analysis and MS Office suite. 
• eClinical Works experience is preferred.
• High School diploma or GED required. 
• Billing Certification required. 
• Demonstrated knowledge of all Insurance companies, HMO’s, PPO’s Government and State programs Medi-Cal and Medicare, and third-party payers.
• Experience with managing revenue cycle processes including Medicaid and Medi-Cal eligibility, health information management and billing, and charge capture processes.

Responsibilities:

Performs a combination, but not necessarily all, of the following duties:

• The billing department encompasses medical coding, charge entry, claims submissions, payment posting, accounts receivable follow-up, and reimbursement management.
• Works through patient insurance documentation, billing and collections, and data processing to ensure accurate billing and efficient account collection.
• Analyzes billing and claims for accuracy and completeness; submit claims to proper insurance entities and follow up on any issues.
• Follows up on claims using various systems, such as eClinical Works, Claim Remedi clearinghouse, Medicare DDE, Online payer sites, etc.
• Maintains contacts with other departments to obtain and analyze patient information to document and process billings.
• Analyzes trends impacting charges, coding, collection, and accounts receivable.
• Successfully scrubs and quality controls claims prior to submission.
• Works the A/R, works rejected claims, and provides necessary follow-up to ensure successful claim processing.
• Generate month end close patient financial communication letters and statements
• Provide quality control checks of denied claims, the ability to process tracers, process contractual adjustments and allocation of funds; initiate appeals
• Evaluate remittance to ensure accuracy and analysis of CAS and denial codes.
• Maintains strong attention to detail and ability to multi-task.
• Maintains extremely high standards of professional conduct.
• Establishes and maintains effective working relationships with the office staff and Doctors.
• Adheres to policies regarding safety, confidentiality, and HIPAA guidelines.
• Ensures that the activities of the collection operations are conducted in a manner that is consistent with overall department protocol and are in compliance with Federal, State, and payer regulations, guidelines, and requirements.
• Serves as a practice expert and go-to person for denials questions and advice.
• Performs other job duties as assigned.

St. John’s Community Health is an Equal Employment Opportunity Employer