Associate Collection Representative at Revenue Cycle Business Services
Under the direction of the PFS manager (defined below by region), the Associate Collections Representative is responsible for performing insurance liability collection and accounts receivable activities for commercial accounts (PPO, HMO, POS, Managed Medicare/Medicaid, Private etc.) to ensure the timely receipt of insurance liabilities for hospital services. This individual follows up on accounts regularly to verify timely receipt of claim, check claim status, submit required documentation, and track overall claim processing. In addition, this individual identifies functional issues and barriers and reports them to the PFS Manager.
Associate Collections Representative: This individual reports to the Southern California Co-Op PFS Commercial Collections Manager and is responsible for collections activities related to all commercial/private insurance accounts for the Southern California region.
Associate Collections Representative (Southwest): This individual reports to the Regional PFS Manager and is responsible for collections activities related to all commercial/private insurance accounts for the Southwest region.
Ability to work with patients of all ages and explain payor benefits.
Patient may require voice elevation, repetitive information, and require understanding.
Complete and independently manage account follow-up based on preset follow-up guidelines defined by payor type and account balance:
• Verify claim is received by commercial payor timely in accordance with the timely filing limits of the contractual agreement and/or state or federal regulations.
• Monitor accounts receivable daily through worklists and check claim status through payor claims department or online to ensure proper claims processing.
• Complete periodic payor phone calls to confirm claim status and drive claim resolution as dictated by department collections policies.
• Document follow-up activity or pertinent notes (e.g., date of receipt, reference number) within the system of record to track and record overall claim process history.
• Obtain and submit any necessary documentation to support claim processing if required by the contractual agreement, payor guidelines, or state or federal law.
• Report any critical account issues or barriers in the collections process to the Co-Op PFS Manager.
• Trend and document ongoing payor issues and notify PFS management.
Ensure that all activities related to hospital collection functions meet department requirements, maximize revenue collection, and achieve leading practice levels of performance.
Daily focus on attaining productivity standards, recommending new approaches for enhancing performance, and productivity when appropriate.
Review own work for accuracy and completeness prior to end of shift.
Meet productivity and quality goals/standards.
Adhere to state and federal regulations.
Identify and alert a member of the management staff of any situation that may negatively impact the patient, department operations, public relations, or the hospital's integrity.
- Experience in medical management computer applications
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
About the department you will serve.
One Revenue Cycle (ORC) is the name adopted to reflect the Providence employees who work throughout Providence Health & Services (PH&S) in revenue cycle systems and structures in support of our ministries and operations in all regions from Alaska to California. ORC’s objective is to ensure our core strategy, One Ministry Committed to Excellence, is delivered along with the enhanced overall patient care experience (know me, care for me, ease my way) by providing a robust foundation of services, operational and technical support, and the sharing of comprehensive, relevant, and highly specialized revenue cycle expertise.
We offer a full comprehensive range of benefits — see our website for details — http://www.providenceiscalling.jobs/rewards-benefits
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
Requsition ID: P361007
Company: Providence Jobs
Job Category: Billing/Collections
Job Function: Revenue Cycle
Schedule: Full time
Career Track: Admin Support
Department: 4001 SS RC GOV ADM BILL NW
Address: OR Portland 4400 NE Halsey St
Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.