Collections Representative

Software Guidance & Assistance, Inc., (SGA), is searching for a Collections Representative for a contract assignment with one of our premier Healthcare clients in San Leandro, CA .

Responsibilities :

• The PFS Collection Specialist is responsible for all aspects reviewing payer contracts, claims and performing third party collection activity for hospital services.
• Responsible for all aspects of 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.

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.

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.

Prepares documents for collection of revenues from third party payer programs; checks and verifies charge rates for services;

reconciles account balances and verifies payments.

Reviews billing documents to assure program compliance for Medicare, Medi-Cal, Mental Health, and insurance programs; assures that all appropriate medical documentation is submitted timely.

Required Skills :

• High school diploma or equivalent education.
• Minimum Experience : Two years' experience, performing medical billing / collections or medical accounts receivable functions in a healthcare insurance related environment.

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.

• Intermediate computer skills including thorough understanding of the EHR system, Microsoft Office (Word, Outlook, Excel, PowerPoint).
• Intermediate knowledge of UB- and Explanation of Benefits (EOB) interpretation.
• Intermediate knowledge of CPT and ICD- codes.
• Intermediate knowledge of insurance claims and insurance terminology.

Preferred Skills :

• years of experience in a hospital business environment performing billing and / or collections.
7 hours ago