Patient Rep V-Collector

Overview

Responsible for effectively billing or rebilling all accounts to the appropriate insurance carrier by implementing billing procedures in a timely manner. Responsible and accountable for pursuing collection of all receivables from insurance, guarantor, and/or any other responsible party.

• Continually follows‑up on outstanding accounts through contacts/inquiries to third‑party payors to facilitate prompt resolution and/or payment and actively pursues payment from patient/guarantor on all outstanding account balances after third‑party payment or rejection based upon hospital collection guidelines daily.
• Identifies and investigates delinquent accounts to for special circumstances affecting payment delays and recommends the appropriate disposition.
• Reviews bad debt pre‑list report to ensure that adequate follow‑up/collection efforts have been performed prior to transferring to the bad debt file weekly.
• Phones patients to obtain insurance and COB information and inform them of financial responsibility and discusses various payment options.
• Prepare appropriate billing documents based upon current payor/hospital guidelines for all third‑party payors.
• Prepares and processes any necessary adjustment/coding changes on accounts through the system based upon follow‑up to expedite the collection process and to ensure the accuracy of the account daily.
• Review inpatient and outpatient fins to ensure the accuracy and completeness of all documents.
• Reviews audit discrepancy report, pulls the account, processes the debit/credit adjustments, rebills the account to the third‑party payor and moves monies back to the insurance load.

• Knowledge of UB‑04 and 1500 billing preferred.
• Must have working knowledge of insurance claim filing, collections, and established refund processing procedures.
• Productivity Standards of 75 accounts a day, minimum.
• Quality Standards of 95% A/R aging 90 days less than 30% of total A/R.
• Accounts on WQ's can not be aged more than 30 days.
• Mail and correspondence must be worked within 5 working days.
• Medical Records request follow‑up must be worked within 7 working days from first request.
• Account rejections in Quadax must be turned around within 2 days of receipt.
• Follow up with UM or physician's office on Prior Authorization denial within 1 day of receipt.
• Bad debt accounts to be worked weekly and completed by month end.
• Resolve and complete patient complaints daily.
• Denial Write‑Off rate needs to be