Medical Collector

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

AIM OF THE POSITION:

The Patient Advocate Representative (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. Customer Care, Sales, Commercial and external vendors

2. Cooperates with all departments across the organization

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

* 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