Patient Financial Services Collection Specialist

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  • San Leandro, CA
  • Finance
  • Patient Financial Svcs - Facil
  • Full Time - Day
  • Req #: 24647-16090
  • Posted: September 3, 2019
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Summary

SUMMARY:  The PFS Collection Specialist is responsible for all aspects reviewing payer contracts, claims and performing third party collection activity for Professional Fee services.

 DUTIES & ESSENTIAL JOB FUNCTIONS:  NOTE: The following are the duties performed by employees in this classification.  However, employees may perform other related duties at an equivalent level.  Not all duties listed are necessarily performed by each individual in the classification.
 

1. Responsible for all aspects of Professional Fee follow up and collections on insurance balances, including making telephone calls, accessing payer websites.  Identify issues or trending and provide suggestions for resolution.  Accurately and thoroughly documents the pertinent collection activity performed.  Review the account information and necessary system applications to determine the next appropriate work activity.  Verify claims adjudication utilizing appropriate resources and applications.  Initiate telephone or letter contact to patients to obtain additional information as needed.  Perform appropriate follow-up functions, including manual re-submissions as well as electronic attachments to payers.  Manage and maintain desk inventory, complete reports, and resolve high priority and aged inventory.

2. Participate and attend meetings, training seminars and in-services to develop job knowledge. Participate in the monthly, quarterly and annual performance evaluation process with Supervisor.  Respond timely to emails and telephone messages as appropriate.  Communicate issues to management, including payer, system or escalated account issues.

3. Maintains information or operational records; screens reports for completeness and mathematical accuracy; list, abstracts, or summarizes data; compiles routine report from a variety of sources. 

4. May, as a secondary responsibility, interpret abstracts, orders, notes, invoices,  permits, licenses, etc.; computes and receives fees when the amount is not in question or is readily obtainable from fixed schedules; posts data; and prepares reports in accordance with pre-determined forms and  procedures.

5. Prepares documents for collection of revenues from third party payer programs; checks and verifies charge rates for services; reconciles account balances and verifies payments.

6. Reviews billing documents to assure program compliance for Medicare, Medi-Cal, Managed Care, Mental Health and insurance payer programs; assures that all appropriate medical documentation is included in the billing package.  Assures that all appropriate medical documentation is submitted timely.

7. Interacts with all campuses to resolve accounts.

8. Other duties as assigned.

Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.

MINIMUM QUALIFICATIONS:

  • Required Education: High school diploma or equivalent education.
  • Minimum Experience: One year of experience in a Revenue Cycle area within the Alameda Health System; OR the equivalent of two years’ experience, performing medical billing/collections or medical accounts receivable functions in a healthcare insurance related environment.
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