Claims Collector

Description

General Summary:  The Collector is responsible for ensuring prompt and proper payment of claims and contacting the appropriate entity or individuals if payment is not made promptly.

Patient Population:  Does not have contact with patients.

Supervision:  Does not direct the activities of the staff.

Standard Essential Functions

1. The knowledge and skills necessary to perform the position requirements are demonstrated through the successful completion of competencies established for the position, including the population served and other special needs of patients or customers served by the department.
2. Adheres to LifeCare policies, procedures, all safety plans, and all standards imposed by regulatory organizations.
3. Regular attendance and timeliness are required.

Job-Specific Essential Functions

1. Processes and follows up on third-party collections. Reviews their party aging and follows up on outstanding claims.
2. Contact insurance companies, patients, government agencies, other hospital departments, physician offices, attorney offices, and other third-party payers based on age and past due balances.
3. Reviews and follows up on Explanation of Benefit denials.
4. Submits re-bills, tracers, and appeals; submits adjustments using appropriate reason code classifications. Identifies bad debt accounts for adjustment and identifies credits and refunds.
5. Performs collection duties, rebilling research, correspondence, returned mail, and problem-solving account billing errors.
6. Verifies billing information for electronic claims transmission and hard copy billing and follows up on accounts billed electronically and manually.
7. Reviews remittance advice forms to verify proper reimbursement and adjusts as necessary.
8. Verifies coding with claims processors at third-party payer companies regarding disputes/denied claims and follows up on all bills not processed within the usual claim period.
9. Identify and present bulk collection issues to designated payor representatives for resolution.
10. Become a resource for assisting in resolving collections issues within the organization.

Values

• We COLLABORATE: We develop our treatment plans in collaboration with physicians, clinicians, and patients' families.
• We ADVOCATE: We advocate on behalf of every patient and family.
• We RESPECT: We recognize and value the dignity, rights, and resources of each patient.
• We EDUCATE: We educate our team members and families with purpose and compassion.
• We SERVE: We serve as a TEAM with integrity at all levels, focused on achieving the best possible outcomes for our patients.

Qualifications

Experience: Two years of hospital collections experience.

Education: High school diploma or equivalent required.

Licensure/Certification: None

Physical Requirements:

1. Sedentary Work: Exerting up to 10 pounds of force occasionally or a negligible amount frequently to lift, carry, push, pull, or otherwise move objects, including the human body. May involve sitting most of the time but may involve walking or standing for brief periods.
2. Sitting or standing, bending, stooping, and carrying items weighing up to 20 pounds.
3. Constant adequate range of motion and mobility required.
4. Regular near acuity with clarity of vision at 20 inches or less is required.
5. Typical ability to collect and analyze numerical and written data and verbal information to reach logical conclusions and ability to determine the time, place, and sequence of operations or actions required.
6. Regular talking and the ability to express and exchange ideas utilizing language is expected.
7. Regular hearing and the ability to perceive the nature of sounds.
8. Constant ability to read, record, or type data quickly and accurately is required.

Environmental/Working Conditions:

1. Category 3: Job tasks involve no greater exposure to blood, body fluids, or tissues than would be encountered by a visitor. The typical work routine involves no exposure to blood, body fluids, or tissue, and the worker can decline to perform tasks without retribution.
2. Working long hours between breaks or meals is required.
3. Must be willing to travel overnight to various locations as needed.
4. Ability to work under and handle stress in an appropriate manner required.
5. May be exposed to high, medium, or low noise intensity.
6. Constant contact with third parties, co-workers, and guests is required.

Machinery/Tools/Equipment Requirements:  Fax machine, telephone, copy machine, computer, printer, and calculator.