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- High School Diploma or equivalent required.
- 3-4 years of previous hospital billing / collection is desirable.
- Familiarity with computer and / or data entry and medical terminology.
- Good communication skills, including the ability to project the Hospital’s Service Quality Initiative.
- Good organizational skills.
Responsible for inpatient and outpatient collections of high balance Commercial /HMO and Self Pay balances. Specializes in Managed Care reimbursement contracts to ensure correct reimbursement.
- Makes initial call to third party payers to confirm that bill is in the third party system and being processed.
- Follows through on any claim not being processed or suspended for additional information.
- Documents in collection note entry function review of account.
- Re-bills account if necessary and obtains additional documents if needed e.g. appeal letter, physician letter to resolve account.
- Follows through on initial call to payer or other necessary party to collect correct payment.
- Identifies problems e.g. patterns of payer specific issues or contract management issues with copies of examples to the HMO Reimbursement Supervisor and Director.
- Refers for approval any manual allowances to Supervisor and documents account reason why manual allowance put through.
- Coordinates Managed Care Carveout Billing, including Implants/Drugs with hospital departments and forwards billing to applicable payor provider representatives for payment.
- Keeps abreast of collection laws and regulations.
- Keeps abreast of payer mix and rate changes.
- Processes all applicable mail, telephone and in person inquiries for the assigned accounts.
- Responds to payers and patient mail in a timely manner.
- Alerts Supervisor of any billing problems identified while reviewing account.
- Alerts Supervisor of any computer system problems.
- Provides general Hospital information to patients and / or directs more specific inquiries to the appropriate party.
- Performs related duties as required.
*ADA Essential Functions