Description

Robert Half is seeking out candidates in with outstanding customer service and coding skills for a Medical Collections Specialist position with one of its Fortune 500 healthcare clients that is located in Costa Mesa, CA.

The Medical Collections Specialist will:

• Greet Completes assigned accounts within assigned work queues.

• Obtains the maximum amount of reimbursement by evaluating claims at the contract rate with the use of the contract management tool for proper pricing (Examples: APC, DRG, APRDRG).

• Reviews and initiates the initial appeal for underpayments observing all timely requirements to secure reimbursement.

• Reviews and completes payor and/or patient correspondence in a timely manner.

• Escalates to the payor and/or patient accounts that need to be appealed due to improper billing, coding and/or underpayments.

• Reports new/unknown billing edits to direct supervisor for review and resolution.

• Has a strong understanding of the Revenue Cycle processes, from Patient Access (authorizations admissions) through Patient Financial Services (billing & amp; collections), including procedures and policies.

• Has thorough knowledge of managed care contracts, current payor rates, understanding of terms and conditions, as well as Federal and State requirements.

• Interprets Explanation of Benefits (EOBs) and Electronic Admittance Advice (ERAs) to ensure proper payment as well as assist and educate patients and colleagues with understanding of benefit plans.

• Understanding of hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms.

• Knowledge of HMO, POS, PPO, EPO, IPA, Medicare Advantage, Covered California (Exchange), capitation, commercial and government payors (i.e. Medicare, Medi-Cal, TriCare, etc) and how these payors process claims.

• Demonstrates knowledge of and effectively uses patient accounting systems.

• Documents all calls and actions taken in the appropriate systems.

• Accurately codes insurance plan codes.

• Establishes a payment arrangement when patients are unable to pay in full at the time payment is due

  Requirements

In addition to the above-stated duties, the Medical Collections Specialist must hold the following skills:

• Excellent verbal and written communication skills.

• Problem-solving skills.

• Must have EPIC experience.

• One year of previous hospital business experience, or equivalent required or strong background in customer service.

• Basic experience with insurance plans, hospital reimbursement methodology, and/or ICD10 and CPT coding.

Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.

Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more.

All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.

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