Underpayment & Overpayment Collector – Healthcare (REMOTE)

Job Summary

The Payment Compliance & Contract Management (PCCM) Collector is responsible for the timely and efficient resolution of underpaid and overpaid accounts. This role involves managing account follow-up, analyzing trends, collaborating with internal departments, and ensuring accurate reconciliation of account balances. The PCCM Collector assists in optimizing revenue cycle processes and maintaining compliance with contractual agreements.

Essential Functions

• Manages account follow-up for underpaid and overpaid claims, escalating unresolved issues internally as needed to achieve resolution.
• Reconciles account balances and adjustments to ensure accurate financial status and compliance with contractual terms.
• Resolves underpayments by engaging in daily communication with payers and negotiating payment discrepancies.
• Identifies and analyzes trends in underpayments, overpayments, denials, and revenue opportunities to recommend process improvements.
• Evaluates and interprets contract reimbursement details, providing feedback and insights to the department to enhance revenue cycle performance.
• Collaborates with financial and clinical departments to address account discrepancies and ensure effective revenue management.
• Reviews contract validation, updates, and provides interpretation to support accurate claim processing and collections.
• Ensures thorough and accurate validation of account analysis before distribution, maintaining compliance with policies and procedures.
• Performs other duties as assigned.
• Maintains regular and reliable attendance.
• Complies with all policies and standards.

Qualifications

• H.S. Diploma or GED required
• Associate Degree or higher preferred
• 1-2 years of experience in healthcare collections, revenue cycle, or contract management required
• Familiarity with payer contracts and healthcare reimbursement methodologies preferred

Knowledge, Skills and Abilities

• Strong analytical and problem-solving skills.
• Proficient in understanding and interpreting payer contracts and reimbursement terms.
• Effective communication and negotiation skills.
• Ability to work independently and manage multiple priorities in a fast-paced environment.
• Proficiency in healthcare billing software, Google Suite, and Microsoft Office Suite, especially Excel.
• Attention to detail and high degree of accuracy in reconciliation and analysis.