Medical Collector - Alura Workforce Solutions

POSITION
Title: Medical Collector
Position Type: Full-Time, Direct Placement
Location: Orange and/or Laguna Niguel - On-Site
Schedule: M-F, 8:00 am - 4:30 pm

DESCRIPTION
Medical Collector
(Home Infusion AR Experience Required)

As a Reimbursement Specialist/Medical Collector, you will be responsible for accurate and timely claims reimbursement activities, including working with home infusion IVIG, TPN, and Medicare claims. Your role will involve handling appeals, interactions with third-party payers and patients, as well as maintaining accurate records.

ESSENTIAL FUNCTIONS

• Reviews patient inventory of assigned accounts
• Reviews accuracy of claims submitted and communicates to team members and management on any process inefficiencies and billing errors resulting in claim denials and underpayments
• Verifies newly submitted claims status to ensure that claims are on file with insurance, in process, and hold payers accountable for accurate and timely reimbursement
• Reviews accuracy of claim payments received from payers and patients
• Identify and communicate to the management team in a timely manner on inadequate reimbursement rates that may require a pharmacy transfer
• Submits appeals and pursues additional payments on any medical claims denied in error or paid less than the expected reasonable maximum allowable rate for the procedure codes submitted and level of patient's benefit coverage
• Submits letter of negotiations and obtain payment resolutions from claim payers
• Performs collections on patient balances ensuring maximum reimbursement for all services provided
• Ensures submission of complete and appropriate clinical documentation when justifying claims medical necessity
• Independently perform claims follow-up and collections activities such as resolving claims denials and rejections through claim resubmissions, corrected claims and appeals in compliance with Billing Department's approved reimbursement strategies in a timely manner
• Effectively review and interpret benefits details and Identify and communicate on any inaccuracies in benefit details affecting claims reimbursement
• Document detailed claim status on each patient's account (new or otherwise) accurately and in a timely manner
• Creates and utilizes reminders and follow up reports to ensure completion of any incomplete or pending activities
• Escalates to management on any unresolved claim issues after proper claim resolution attempts that have been made
• Maintains a positive DSO on assigned account inventory
• Provides the highest level of customer service in answering patient phone calls and resolve patients' questions and/or billing issues, as well as communicate with doctors' offices and their staff
• Identifies and communicates to the management team on any incomplete or inaccurate billing related databases resulting in billing errors and process delays in a timely manner
• Ensures compliance with all payer rules and regulations
• Ensures compliance with all company policies and procedures
• Other duties as assigned

REQUIREMENTS

• High School Diploma
• Minimum of two-years Home Infusion AR (IVIG/TPN and RX) collections experience required.
• Knowledge of Government Appeals, and submission guidelines
• Experience as a medical coder/biller with a working knowledge of managed care, commercial insurance, Medicare, and Medicaid reimbursement
• Knowledge of ICD 10, CPT, HCPC, J billing codes and medical terminology
• Knowledge of reimbursement appeal strategies and claims escalations
• Knowledge of automated billing systems and CMS HCFA 1500 form
• Advanced knowledge of Word, Excel, and Outlook functions