Collection Representative

SHIFT:
Day (United States of America)
Seeking Breakthrough Makers
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We strongly encourage all candidates of diverse backgrounds and lived experiences to apply.
A Brief Overview
Under the supervision of the Collection Manager, this individual is responsible for timely resolution of patient accounts. Assigned duties include collection calls to parents and insurers, payor relations and financial management of accounts receivable.
What you will do

• Reviews remittance advices (RAs) and explanation of benefits (EOBs) of assigned payors/accounts.
• Reviews accuracy of RAs/EOBs on a weekly basis; contacts payors to resolve inappropriate denials/rejections.
• Works with other CHOP departments (ie: Case Management, Medical Records, Credit and Billing) to appeal legitimate denials.
• Advises supervisor of contractual problems on a weekly basis.
• Resolves patient accounts billed to insurance payers or directly to the guarantor.
• Conducts at least 60 daily telephone calls or accesses Payer website to insurances and/or responsible party to inquire on status of claims.
• Sends and receives payor correspondence via mail and/or fax on a daily basis.
• Utilizes account work queues to expedite resolution of outstanding accounts.
• Completes 90% of work list (or other mutually agreed percentage) on a weekly basis.
• Reviews account work queues for thoroughness and applicability to workload with supervisor on a monthly basis.
• Maintains complete, accurate and up-to-date account history for each account.
• Reviews appropriateness of account balances (ie: allowances, late charges, duplicate charges, insurance and patient balance, etc) on a monthly basis.
• Enters comments in account notes system for all patient accounting activity.
• Escalate individual problem accounts to Supervisor or Manager.
• Identify payer trends for denials
• Preparation for Payer meetings.
• Maintains orderly filing system.
• Coordinates medical record requests and audit request of payors.
• Submits requests for medical records within two working days.
• Refers bills and audits to internal auditor on a weekly basis archiving on a weekly basis.
• Performs other duties as assigned.

• High School Diploma / GED Required
• Bachelor's Degree Preferred

• Healthcare experience and/or claims processing, billing, collections or customer service experience Preferred

• Must have the ability to follow through with any patient financial problems until they are adequately resolved.
• Good working knowledge of third party insurance and public assistance programs.
• Good working knowledge of hospital computer information systems (ie: SMS IDX or EPIC).
• Must have excellent organizational, written and verbal communication skills.