Representative - Collections L1

POSITION SUMMARY
Collections Representative is responsible for follow up on delinquent surgery center claims, working an expected number of claims per day. Majority of claims will have been submitted to various insurance carriers electronically. Knowledge of how to interpret a managed care contract, Medicare and Medicaid and Workers Compensation claims is a must. You will be given tools to calculate allowable and required to determine appropriateness of reimbursement and appeal claims as necessary.

ESSENTIAL FUNCTIONS

• Contact payors and patients to effectively and accurately collect for services provided by Atlas centers.

• Interpret a managed care contracts, Medicare and Medicaid and Workers Compensation to appropriately calculate allowable and determine appropriateness of reimbursement.

• Interpret patient eligibility and plan structure to determine patient responsibility.

• Answer questions regarding account aging, denial types and other requests for analysis and detail by account, center, denial type or any other claim and invoice characteristics.

• Participate as a team player, and have ability to communicate well with team members, patients, customers, insurance carriers, etc.

• Apply the appropriate strategy to account resolution including thresholds for refunds, recoups, write offs, adjustments and productivity targets.

• May work payments, adjustments, claims, correspondence, refunds, denials, financial/charity applications, and/or payment to help the team meet goals in work quality and productivity.

• Identifies payer, center, and denial trends and shares those results with collections leaders.

Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.

NOTE: The essential functions are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Specific tasks or responsibilities will be documented as outlined by the incumbent's immediate manager.

ESSENTIAL FUNCTIONS

• Contact payors and patients to effectively and accurately collect for services provided by Atlas centers.

• Interpret a managed care contracts, Medicare and Medicaid and Workers Compensation to appropriately calculate allowable and determine appropriateness of reimbursement

• Interpret patient eligibility and plan structure to determine patient responsibility

• Answer questions regarding account aging, denial types and other requests for analysis and detail by account, center, denial type or any other claim and invoice characteristics

• Participate as a team player, and have ability to communicate well with team members, patients, customers, insurance carriers, etc.

• Apply the appropriate strategy to account resolution including thresholds for refunds, recoups, write offs, adjustments and productivity targets.

• May work payments, adjustments, claims, correspondence, refunds, denials, financial/charity applications, and/or payment to help the team meet goals in work quality and productivity.

• Identifies payer, center, and denial trends and shares those results with collections leaders.
  Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.
  
  NOTE: The essential functions are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Specific tasks or responsibilities will be documented as outlined by the incumbent's immediate manager.

MINIMUM QUALIFICATIONS

• High school diploma or GED required.
• Requires knowledge of at least one of the following: patient financial services, financial, collecting services, or insurance industry experience processes normally acquired over up to two years of work experience.
• Requires the ability to manage multiple tasks simultaneously with minimal supervision and to work independently.
• Requires strong interpersonal, oral, and written communication skills to effectively interact with a wide range of audiences.
• Strong knowledge in the use of common office software, word processing, spreadsheet, and database software are required.

PREFERRED QUALIFICATIONS

• Additional related education and/or experience preferred.

PHYSICAL DEMANDS/ENVIRONMENT FACTORS
OE - Typical Office Environment: (Accountant, Administrative Assistant, Consultant, Program Manager)

• Requires extensive sitting with periodic standing and walking.
• May be required to lift up to 20 pounds.
• Requires significant use of personal computer, phone and general office equipment.
• Needs adequate visual acuity, ability to grasp and handle objects.
• Needs ability to communicate effectively through reading, writing, and speaking in person or on telephone.
• May require off-site travel.

SUPERVISORY RESPONSIBILITIES

• None

DIRECTLY REPORTING

• Supervisor - Payment & Support Operations

TYPE OF SUPERVISORY RESPONSIBILITIES

• N/A

SCOPE AND COMPLEXITY

• Works independently under regular supervision and follows structured work routines. Works in a fast paced, multitask environment with high volume and immediacy needs requiring independent decision making and sound judgment to prioritize work and ensure appropriateness and timeliness of each patient’s care. This position requires the ability to retain large amounts of changing payor information/knowledge crucial to attaining reimbursement for the services provided. Primary external customers include patients and their families, physician office staff and third-party payors.