Reporting to the Collections Supervisor, Level 2 RCM Collector must have a strong knowledge of medical collections, accounts receivables, denial processing, appeal submission and EOB review. This position is responsible for resolving outstanding surgical claims resulting in maximum reimbursement.
- Act as a resource for all critical aspects of the CBO which includes liaising between departments as well as assisting Level 1 Collectors.
- Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers including self-pay to obtain maximum reimbursement.
- Manage daily work queue to prioritize high dollar claim balances.
- Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD’s) for claim resolution.
- Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents.
- Ability to review medical documentation to justify medical necessity.
- Send appeals when appropriate or provide the requested medical documentation.
- Knowledge of working with Fee Schedules/Payor Contracts
- Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.
- Work 30 accounts daily with > or =90% accuracy rating; meet department productivity standards.
This is not an all-inclusive list. Additional tasks and responsibilities may be added by management based on business need.
Required Skills
Required Skills/Experience
- 2-3 Years previous third-party payer experience or some hospital clerical experience or medical terminology preferred.
- Must demonstrate a positive demeanor, good verbal, and written communication skills, and be professional in both appearance and approach. Must be able to handle potentially stressful situations and multi-task and handle competing priorities while meeting or exceeding deadlines.
- Maintains appropriate account level reviews to ensure timely account processing. Executes aggressive, accurate and timely follow-up on accounts according to established policies and procedures for assigned facility/aging bucket.
- Any of the following: Cerner, nThrive, Advantx, Waystar, Meditech, and/or EffecientC experience preferred.
- Must have Intermediate computer proficiency in Microsoft Office including Excel and Outlook.
- Strong mathematical skills, research, analysis, decision making and problem-solving skills.
- High school graduate or equivalent.
Preferred Skills
- Demonstrates excellent problem-solving skills and negotiating skills.
- Personal qualities of integrity, credibility, accountability, and commitment to the practice; a proactive, hands-on person who will work in partnership to enhance overall value and visibility of the organization.
Required Experience