Medical Collections - Medi-Cal Rep 24-00835 - Alura Workforce Solutions

Position
Medical Collector / Authorizations Rep
(Physician Medi-Cal, CCS/SARS Claims)

Description
The Revenue Cycle Support Services Associate I coordinates and performs all collections follow-up on Medi-Cal/CCS denied authorizations and, if necessary, requests new and/or modified authorizations from both automated and manual payers in accordance with training materials, scripts, and standard operating procedures. The position also performs a variety of duties, including reviewing overpayments, credits, and recoupments. Other duties may include making phone calls and/or using payers' web portals to check patient eligibility or confirm the status of pending recoupments.

Essential Duties of the Position

• Follows up on Medi-Cal/CCS denied authorizations and, if necessary, requests new and/or modified authorizations from both automated and manual payers.
• Reviews correspondence related to refunds or recoupments.
• Works with Finance and other Revenue Cycle Departments to optimize the cash posting, balancing, and reconciliation process.
• Responsible for evaluating credit balances and ensuring that refunds are issued to the appropriate payer in a timely and accurate manner.
• Ability to work on special projects as needed by management.
• Investigates unapplied cash receipts and resolves or escalates in a timely manner to lead or supervisor.
• Reverses balance to credit or debit if charges were improperly billed.
• Contacts insurance carriers as necessary to determine correct payment application.
• Communicates issues related to payment posting and refunds from payers to management.
• Updates correct payer information and resubmits claims to the appropriate payer(s).
• Consistently meets/exceeds productivity and quality standards.
• Performs other related duties as assigned by the management team.

Requirements

1. Minimum of three (3) years of healthcare experience in insurance verification, collections, cash posting, and refunds, with exposure to insurance verification, billing, or collections required.
2. Knowledge of Medi-Cal, CCS-SAR payors, and authorization guidelines required.
3. Familiarity with payer billing and reimbursement guidelines and regulations, including the ability to read and interpret payer Explanation of Benefits (EOB) and Remittance Advice Details (RAD).
4. Proficient in all Microsoft Office software applications and EMR systems such as Athena.
5. Ability to communicate effectively in both written and verbal formats with internal and external stakeholders.
6. Ability to organize and manage time effectively.
7. Handle all correspondence, documentation, and files in a professional and confidential manner, following HIPAA and PHI guidelines.
8. Ability to be analytical, flexible, innovative, self-motivated, and work independently as well as part of a larger team.
9. High School Diploma or equivalent required.

Additional Information
Full-Time, Monday - Friday 

INDH