Tandem Hospital Partners

Medical Collector

US-TX-Houston
Job ID
2017-1213
# of Openings
2
Category
Administrative/Clerical
Corporate Office

Overview

 Tandem Logo

Tandem Hospital Partners works with leading hospital systems across the U.S. to build and operate state-licensed, CMS-accredited, acute care neighborhood hospitals.  These next-generation hospitals offer convenient, 24/7 neighborhood access to high quality, compassionate emergency and inpatient care, offering low wait times and an exceptional patient experience.

 

Tandem’s strong clinical, retail, and hospital experience establishes us as the preferred partner in this emerging, innovative industry segment with the most experienced, collaborative, values-driven leadership team.  By partnering with Tandem, hospitals can meet the growing demand for emergency and inpatient services in communities where they are currently underrepresented, providing more convenient access to high quality, integrated and patient-centered care.

 

Job OpportunityMedical Collector

 

Tandem Health Partners is seeking a Medical Collector who will focus on review and resolution of facility related Accounts Receivable. They will review account information and remittance advice forms to verify proper reimbursement and follow up on resolution of accounts. Processing and follow-up with third party collections. Verifying that records for patients include all information required for Third Party reimbursement. Handling collections, denials and appeals and checking claim status. Consult with claims processors at Third Party Payer companies regarding disputes/denied claims and follow up on all bills not processed within allowed claim period.

 

Responsibilities

Essential Functions

  • Upholds the values and mission of the Tandem Hospital Partners family
  • Responsible for all aspects of account follow up and collections, including processing appeals
  • Reviews explanation of benefits (EOBs) to ensure proper reimbursement of claims and reports any problems, issues, or payer trends
  • Collaborates with management to reduce aging of accounts by providing verbal and written communication
  • Work daily claim rejection lists in billing software and clearinghouse queues; correct and set claims to rebill
  • Works with payers to determine reasons for denials
  • Corrects and reprocesses claims for reimbursement in a timely manner
  • Accurately and thoroughly documents the pertinent collection activities in appropriate system
  • Answers questions from patients, clerical staff and insurance companies
  • Prepares, reviews and sends patient statements
  • Evaluates patient’s financial status and establishes budget payment plans. Follows and reports status of delinquent accounts to Manager
  • Identifies and resolves patient collection complaints
  • Ability to learn new computer applications quickly and independently and become a skilled user of the company’s or JV partner’s proprietary database
  • Participates and attends monthly staff meetings
  • Maintains PHI and HIPPA patient confidentiality standards for medical and financial information
  • Contribute to team environment by performing other duties as assigned

Qualifications

Minimum Qualifications

  • 3+ years hospital and/or physician billing and collections experience required
  • High school or GED required

Knowledge, Skills and Abilities

  • Data entry experience
  • Basic understanding of medical terminology
  • Advanced computer skills including Microsoft Office; Word and Excel
  • Proficiency with numbers
  • Basic math skills
  • Experience with 835 ERA files
  • Ability to analyze accounts and determine next appropriate action(s) for account resolution
  • Ability to identify, resolve and escalate trends to ensure timely payment
  • Ability to devise and execute formal appeals on denied and/or underpaid claims
  • Ability to monitor trends in carrier issues regarding reimbursement
  • Ability to learn new computer applications quickly and independently
  • Ability to prioritize Aged Trial Balance and work different aging buckets (30,60,90,120+)
  • Ability to work in a collaborative, team environment
  • Ability to be well organized, detail-oriented, in a fast-paced environment
  • In depth knowledge of Medicare, Medicaid, Workers Compensation and commercial payer reimbursement policies and procedures
  • Must be able to interpret an insurance Explanation of Benefits (EOB) and know the meaning of copay,            deductible and coinsurance
  • Skill in answering a telephone in a pleasant and helpful manner
  • Knowledge of physician (CMS-1500) and facility billing (CMS-1450/UB-04)
  • Knowledge of online carrier websites/portals and ability to retrieve and print Explanation of Benefits as needed
  • Knowledge of basic medical coding
  • Knowledge of filing deadlines for government and commercial payors
  • Knowledge of carrier specific appeals processes and their required forms
  • Knowledge of HIPAA and PHI guidelines
  • Knowledge of in and out of network models
  • Familiarity with Medicare LCDs commercial payor Clinical Policy Bulletins
  • Familiarity with NCCI (National Correct Coding Initiative) edits
  • Excellent communication and problem solving skills
  • Must be well organized and detail oriented
  • Customer service oriented
  • Knowledge of office administration procedures with the ability to operate most standard office equipment
  • Accuracy required

 

Location

Downtown, Houston, TX

 

Travel Required

Up to 25% depending business needs

 

Eligibility Requirements

If you are applying for a position in the United States, you must be at least 18 years of age, legally authorized to work in the United States, and not require sponsorship for employment visa status (e.g. TN, H1B status), now or in the future.

Tandem Hospital Partners strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. THP is proud to be an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, age, disability, Veteran status, gender identity or expression, genetic information or any other legally protected status. We maintain a drug-free workplace and perform pre-employment substance abuse testing.

 

The essential functions listed are typical examples of work performed by positions in this job description and are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks and responsibilities. Specific duties and responsibilities may vary depending on department or program needs without changing the general nature and scope of the job or level of responsibility. Employees may also perform other duties as assigned.

 

Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.

 

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