Job Detail

**Lucrative incentive opportunity ranging from $1,000-$9,000 per quarter

JOB SUMMARY:

The Medical Collector follows-up on the status of submitted claims and invoices; requests medical records as needed; prepares various medical appeals and the submissions of such appeals to insurance carriers; follows-up on all submitted medical appeals in a timely manner.

POSITION WITHIN THE ORGANIZATION:

1. Reports to Reimbursement Supervisor2. Cooperates with all departments across the organization3. Organizes activities with Customer Care, Sales, Commercial and external vendors4. Participates in:– Department meetings– Project meetings– Working groups– Project groups

ESSENTIAL DUTIES AND RESPONSIBILITIES:

· Collects money due from insurance companies, hospital and patients in compliance with CLIA, OIG and all other applicable legal requirements.

• Contacts insurance companies to follow up on claims and appeals which have been submitted, but no payment or correspondence received within the allotted time frame.
• Processes and follows up with patients for copays and deductible amounts due.
• Contacts clients to obtain medical records as needed for submission of a medical appeal or payer’s review of a claim.
• Prepares custom appeal letters and letters of interest to various insurance carriers and managed care groups.
• Reviews files to determine if amounts should be written off based on acceptable reimbursement, then forwards these to the Reimbursement Manager.
• Investigates and prepares any necessary refund requests from payors for submission to the Reimbursement Manager.
• Negotiates reimbursement single settlements with various insurance carriers and third party administrators, based upon department guidelines.
• Interfaces with insurance company representatives, doctor’s offices and hospitals regarding schedule of services and billing inquiries.
• Assists department director in the development of new procedures and systems to enhance productivity.
• Provides account information to the sales force as needed.

The above listing represents the general duties considered essential functions of the job and is not to be considered a detailed description of all the work requirements that may be inherent in the position.

KEY CONTACTS:

· Internal: This position may interface with all departments within the company.

· External: External Vendors

EDUCATION AND EXPERIENCE REQUIREMENTS:

EDUCATION

Education:

· High school diploma or general education degree·

Experience:

· 3+ years related experience

KNOWLEDGE, SKILLS AND ABILITIES (KSA'S):
Specific Knowledge Required:

Knowledge: Comprehension of a body of information acquired by experience or study.

Skill: A present, observable competence to perform a learned activity.

Ability: Competence to perform an observable behavior.

· Advanced technical knowledge of Microsoft products required (Excel, Word, Outlook)

· Must be able to work in a fast-paced environment

· Must have strong organizational skills and attention to detail

· High degree of accuracy

· Manage multiple tasks independently

· Other skills necessary are accounting, data entry, general math, analytical, thoroughness, research, verbal/written communication

BEHAVIOURAL COMPETENCIES/DESIRED SKILLS:

· Excellent problem resolution

· Excellent customer service skills

· Outside-the-box thinker

· PRIVACY NOTICE: To review the California privacy notice, click here: https://agendia.com/privacy-policy/

· Employees must not be classified as an excluded individual who is prohibited from participation in any Federal health care program.

WORKING ENVIRONMENT:

Establishes ADA (Americans with Disabilities Act) requirements

ENVIRONMENT/SAFETY/WORK CONDITIONS:

Working conditions (inside or outside the office)

• General office environment. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Maintains a clean, neat, and orderly work area.
• Adheres to Department Specific Safety Guidelines.
• Standing, sitting, walking, bending, reaching, manual manipulation, and lifting up to 15 pounds.

TRAVEL:

No travel is required.

OTHER DUTIES:

Other duties as required by management

Job Type: Full-time

Pay: $23.00 - $29.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Education:

• High school or equivalent (Required)

Experience:

• ICD-10: 1 year (Required)
• Medical Billing: 3 years (Required)

Ability to Relocate:

• Irvine, CA 92618: Relocate before starting work (Required)

Work Location: In person