USS: MH PBO
Our mission is to continue the teaching and healing ministry of Jesus Christ. Our core values are compassion, integrity, excellence, teamwork and wholeness.
The Collection Specialist analyzes and interprets Managed Care contract language, terms, conditions and responsibility matrices. Performs telephone and written follow-up with insurance companies, third party payers, worker's compensation payers, medical groups, outside hospitals, and physician's offices to ensure timely payments of inpatient and outpatient hospital bills in accordance with the terms and conditions of each contract and/or insurance company policies.
Ensures that payers adhere to compliance laws regarding timely processing of claims. Has a strong understanding of Managed Care and insurance company payment principles, rules, and regulations to perform reimbursement from both the third party and patient perspectives. When working with individual payers on an account-by-account basis, determines if payer needs additional information, identifies barriers, or secures payment dates.
Responsible for following through with requested information as needed in order to remove payment barriers. If unable to remove barriers, elevates the account to either LLUMC Management or Payer Management. Develops collection recovery strategies with each payer.
Must aggressively pursue each outstanding account to reach maximum reimbursement and closure. These services may be provided for both the LLUMC and LLUCH hospitals. Performs other duties as needed.
High School Diploma or GED required. Associate's Degree preferred. Minimum two years of experience in healthcare billing, auditing, managed care or collections required; preferably in hospital billing.
Familiar with automated billing, follow-up and adjudication systems required (i.e., Emdeon, MedAssets, HIPAA, FCA, etc.). Knowledge of UB04, CPT, HCPC, ICD9, and EOB required. Able to keyboard 40 wpm and 10-Key.
Able to read, write legibly; speak in English with professional quality; use computer, printer, and software programs necessary to the position (e.g., Word, Excel, Outlook, PowerPoint). Operate/troubleshoot basic office equipment required for the position. Able to relate and communicate positively, effectively, and professionally with others; work calmly and respond courteously when under pressure; collaborate and accept direction. Able to communicate effectively in English in person, in writing, and on the telephone; think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision. Able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone, and identify and distinguish various sounds associated with the workplace; see adequately to read computer screens, and written documents necessary to the position.
Organization: Loma Linda Unv Shared Services
Benefits Eligible : Yes
Employee Status: Regular
Shift: Day Job
Days of Week: Monday, Tuesday, Wednesday, Thursday, Friday
Loma Linda University Medical Center